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General NPI Number Information
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NPI Number | 1043088396
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Entity Type | Organization
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Legal Business Name | BERGEN PROSTHODONTICS LLC
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Dates
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Enumeration Date | 12/15/2023
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Last Update Date | 12/15/2023
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Provider Practice Location Address
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Address Line | 102 CHESTNUT RIDGE RD STE 201
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City | MONTVALE
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State | NJ
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Zip | 07645-1856
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Country | US
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Telephone | 201-582-2264
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Fax |
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Provider Business Mailing Address
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Address Line | 22 GARNET DR
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City | WOODLAND PARK
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State | NJ
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Zip | 07424-4215
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Country | US
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Telephone | 201-988-5633
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Fax |
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Authorized Official
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Title or Position | CEO/DENTIST
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Name | DR. SUNG EUN KIM
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Credential | DMD, MMSC
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Telephone | 201-582-2264
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0700X
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Taxonomy Name | Prosthodontics
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License Number |
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License Number State |
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