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General NPI Number Information
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NPI Number | 1639387046
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Entity Type | Organization
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Legal Business Name | WALDWICK DENTAL CENTER
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Dates
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Enumeration Date | 05/18/2007
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Last Update Date | 11/25/2014
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Provider Practice Location Address
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Address Line | 22 WYCKOFF AVE
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City | WALDWICK
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State | NJ
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Zip | 07463-1718
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Country | US
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Telephone | 201-447-3210
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Fax |
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Provider Business Mailing Address
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Address Line | 22 WYCKOFF AVE
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City | WALDWICK
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State | NJ
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Zip | 07463-1718
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Country | US
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Telephone | 201-447-3210
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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. STEVEN L KIM
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Credential | D.D.S
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Telephone | 201-447-3210
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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 | 19318
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License Number State | NJ
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