MEDICARE: DEAR DENTAL PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1174304216
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DEAR DENTAL PC

Provider Business Mailing Address
First Line	:	110 LIVINGSTON ST APT 7N
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11201-5061
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	890 MOUNTAIN AVE STE 310
Second Line	:
City	:	NEW PROVIDENCE
State	:	NJ
Zip	:	07974-1240
Country	:	US
Telephone Number	:	551-222-0072
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	BOKHUNG KIM
Credential	:	DMD
Telephone Number	:	267-884-2419

Provider Enumeration Date	:	10/12/2023
Last Update Date	:	10/12/2023

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