Provider Demographics
NPI:1093831810
Name:MIDCOUNTY ENDODONTIC GROUP PA
Entity Type:Organization
Organization Name:MIDCOUNTY ENDODONTIC GROUP PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DMD
Authorized Official - Prefix:DR
Authorized Official - First Name:YOUNG
Authorized Official - Middle Name:JIN
Authorized Official - Last Name:HAHN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:201-652-3311
Mailing Address - Street 1:60 W RIDGEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07450-3197
Mailing Address - Country:US
Mailing Address - Phone:201-652-3311
Mailing Address - Fax:201-652-1893
Practice Address - Street 1:60 W RIDGEWOOD AVE
Practice Address - Street 2:
Practice Address - City:RIDGEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07450-3197
Practice Address - Country:US
Practice Address - Phone:201-652-3311
Practice Address - Fax:201-652-1893
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-22
Last Update Date:2008-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI 175071223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty