=====================================================
General NPI Number Information
=====================================================
NPI Number | 1417053265
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HOPEWELL ORTHODONTICS, P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/16/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2603 ROUTE 52 SUITE E
-----------------------------------------------------
City | HOPEWELL JUNCTION
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12533-3215
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 845-221-7700
-----------------------------------------------------
Fax | 845-227-7971
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2603 ROUTE 52 SUITE E
-----------------------------------------------------
City | HOPEWELL JUNCTION
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12533-3215
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 845-221-7700
-----------------------------------------------------
Fax | 845-227-7971
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ORTHODONTIST/PARTNER
-----------------------------------------------------
Name | HYUN K PARK
-----------------------------------------------------
Credential | DMD
-----------------------------------------------------
Telephone | 845-221-7700
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223X0400X
-----------------------------------------------------
Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------