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General NPI Number Information
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NPI Number | 1295179612
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Entity Type | Organization
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Legal Business Name | GLENSIDE DENTAL CARE
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Dates
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Enumeration Date | 04/29/2013
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Last Update Date | 04/29/2013
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Provider Practice Location Address
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Address Line | 201 S EASTON RD
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City | GLENSIDE
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State | PA
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Zip | 19038-4403
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Country | US
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Telephone | 215-886-0666
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Fax | 215-886-3821
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Provider Business Mailing Address
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Address Line | 201 S EASTON RD
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City | GLENSIDE
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State | PA
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Zip | 19038-4403
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Country | US
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Telephone | 215-886-0666
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Fax | 215-886-3821
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Authorized Official
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Title or Position | OWNER
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Name | DR. HYE EUN KIM
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Credential |
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Telephone | 215-886-0666
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DS037074
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License Number State | PA
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