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General NPI Number Information
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NPI Number | 1962764134
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Entity Type | Organization
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Legal Business Name | BO ORTHODONTICS
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Dates
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Enumeration Date | 06/13/2012
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Last Update Date | 06/13/2012
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Provider Practice Location Address
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Address Line | 269 LIVINGSTON ST STE G
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City | NORTHVALE
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State | NJ
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Zip | 07647-1918
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Country | US
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Telephone | 201-470-2757
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Fax |
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Provider Business Mailing Address
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Address Line | 269 LIVINGSTON ST STE G
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City | NORTHVALE
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State | NJ
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Zip | 07647-1918
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Country | US
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Telephone | 201-470-2757
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Fax |
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Authorized Official
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Title or Position | DDS
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Name | SUNG YUN
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Credential |
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Telephone | 201-470-2757
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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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