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General NPI Number Information
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NPI Number | 1841621190
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Entity Type | Organization
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Legal Business Name | BERGENLINE TOP DENTAL
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Dates
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Enumeration Date | 12/11/2013
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Last Update Date | 12/11/2013
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Provider Practice Location Address
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Address Line | 6204 BERGENLINE AVE
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City | WEST NEW YORK
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State | NJ
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Zip | 07093-1619
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Country | US
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Telephone | 201-869-9800
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Fax |
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Provider Business Mailing Address
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Address Line | 6204 BERGENLINE AVE
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City | WEST NEW YORK
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State | NJ
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Zip | 07093-1619
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Country | US
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Telephone | 201-869-9800
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | DR. SUNG YUN
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Credential | DDS
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Telephone | 201-869-9800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 22DI02211400
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License Number State | NJ
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