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General NPI Number Information
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NPI Number | 1487443933
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Entity Type | Organization
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Legal Business Name | BERGEN IMPLANT CENTER PA
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Dates
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Enumeration Date | 05/01/2025
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Last Update Date | 05/01/2025
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Provider Practice Location Address
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Address Line | 384 BROAD AVE
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City | LEONIA
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State | NJ
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Zip | 07605-1715
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Country | US
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Telephone | 201-363-9890
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Fax |
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Provider Business Mailing Address
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Address Line | 384 BROAD AVE
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City | LEONIA
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State | NJ
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Zip | 07605-1715
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Country | US
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Telephone | 201-446-5244
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DONGWOOK KIM
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Credential | DDS
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Telephone | 201-446-5244
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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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