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General NPI Number Information
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NPI Number | 1578677092
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Entity Type | Organization
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Legal Business Name | CLOSTER DENTAL PC
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Dates
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Enumeration Date | 08/19/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 570 PIERMONT RD #C1
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City | CLOSTER
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State | NJ
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Zip | 07624
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Country | US
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Telephone | 201-666-2828
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Fax | 201-750-2314
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Provider Business Mailing Address
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Address Line | 570 PIERMONT RD #C1
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City | CLOSTER
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State | NJ
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Zip | 07624
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Country | US
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Telephone | 201-666-2828
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Fax | 201-750-2314
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Authorized Official
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Title or Position | PRESIDENT
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Name | SUNG RAE KIM
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Credential | DDS
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Telephone | 201-666-2828
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0700X
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Taxonomy Name | Prosthodontics
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License Number | DI19751
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License Number State | NJ
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