Healthcare Provider Details

I. General information

NPI: 1073335360
Provider Name (Legal Business Name): PURCHASE PARK ORTHODONTICS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/28/2024
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3010 WESTCHESTER AVE STE 403
PURCHASE NY
10577-2524
US

IV. Provider business mailing address

3010 WESTCHESTER AVE STE 403
PURCHASE NY
10577-2524
US

V. Phone/Fax

Practice location:
  • Phone: 914-481-1816
  • Fax: 914-481-1816
Mailing address:
  • Phone: 914-481-1816
  • Fax: 914-481-1816

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number StateNULL

VIII. Authorized Official

Name: ARTHUR KIM
Title or Position: OWNER
Credential: DMD
Phone: 914-481-1816