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General NPI Number Information
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NPI Number | 1457923872
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Entity Type | Organization
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Legal Business Name | ETEN DENTAL PLLC
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Dates
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Enumeration Date | 07/14/2021
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Last Update Date | 08/13/2021
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Provider Practice Location Address
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Address Line | 21814 NORTHERN BLVD STE 104
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City | BAYSIDE
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State | NY
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Zip | 11361-3580
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Country | US
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Telephone | 184-231-0107
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Fax | 718-423-1011
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Provider Business Mailing Address
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Address Line | 46 WINTHROP DR
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City | WOODBURY
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State | NY
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Zip | 11797-1315
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Country | US
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Telephone | 516-584-6528
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. EJU HWANG
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Credential | DDS
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Telephone | 718-423-1010
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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 |
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License Number State |
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