Provider Demographics
NPI:1205418571
Name:BC DENTAL FTL, PC
Entity Type:Organization
Organization Name:BC DENTAL FTL, PC
Other - Org Name:BEAM CITY PEDIATRIC DENTISTRY AND ORTHODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/ASSOCIATE
Authorized Official - Prefix:
Authorized Official - First Name:JUN
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:YOO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:201-509-1032
Mailing Address - Street 1:229 MAIN ST P.O. BOX #1238
Mailing Address - Street 2:
Mailing Address - City:FORT LEE
Mailing Address - State:NJ
Mailing Address - Zip Code:07024
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:144-148 LINWOOD PLAZA
Practice Address - Street 2:
Practice Address - City:FORT LEE
Practice Address - State:NJ
Practice Address - Zip Code:07024
Practice Address - Country:US
Practice Address - Phone:201-509-1032
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BC DENTAL FFL, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-04-26
Last Update Date:2021-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty