Provider Demographics
NPI:1316587512
Name:MADISON DENTAL LOFT P.C.
Entity Type:Organization
Organization Name:MADISON DENTAL LOFT P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:YOHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:215-796-8347
Mailing Address - Street 1:30 E 40TH ST RM 602
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-1243
Mailing Address - Country:US
Mailing Address - Phone:646-687-7898
Mailing Address - Fax:646-650-2700
Practice Address - Street 1:30 E 40TH ST RM 602
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-1243
Practice Address - Country:US
Practice Address - Phone:646-687-7898
Practice Address - Fax:646-650-2700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-15
Last Update Date:2020-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty