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General NPI Number Information
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NPI Number | 1417470915
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Entity Type | Organization
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Legal Business Name | WHITE PLAINS DENTAL
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Dates
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Enumeration Date | 07/18/2017
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Last Update Date | 07/18/2017
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Provider Practice Location Address
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Address Line | 3073 DUNDEE RD
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City | NORTHBROOK
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State | IL
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Zip | 60062-2401
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Country | US
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Telephone | 847-496-0158
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Fax |
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Provider Business Mailing Address
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Address Line | 278 SPRING CREEK CIR
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City | SCHAUMBURG
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State | IL
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Zip | 60173-2154
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Country | US
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Telephone | 919-824-9107
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | DR. SUNG HONG
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Credential | DDS
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Telephone | 847-496-0158
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 019029371
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License Number State | IL
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