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General NPI Number Information
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NPI Number | 1306278858
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Entity Type | Organization
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Legal Business Name | 3S ORTHODONTICS, P.A.
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Dates
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Enumeration Date | 08/07/2013
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Last Update Date | 08/07/2013
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Provider Practice Location Address
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Address Line | 669 BROAD AVE STE 102
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City | RIDGEFIELD
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State | NJ
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Zip | 07657-1631
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Country | US
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Telephone | 201-840-1123
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Fax | 201-840-5699
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Provider Business Mailing Address
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Address Line | 669 BROAD AVE STE 102
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City | RIDGEFIELD
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State | NJ
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Zip | 07657-1631
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Country | US
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Telephone | 201-840-1123
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Fax | 201-840-5699
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JINSANG KIM
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Credential |
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Telephone | 201-840-1123
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | DI19437
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License Number State | NJ
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