Provider Demographics
NPI:1467708958
Name:CROWN DENTAL, PLLC
Entity Type:Organization
Organization Name:CROWN DENTAL, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:MR
Authorized Official - First Name:HEEJOON
Authorized Official - Middle Name:
Authorized Official - Last Name:KWAK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:718-239-6929
Mailing Address - Street 1:604 CASTLE HILL AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10473-1402
Mailing Address - Country:US
Mailing Address - Phone:718-239-6929
Mailing Address - Fax:718-239-8602
Practice Address - Street 1:604 CASTLE HILL AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10473-1402
Practice Address - Country:US
Practice Address - Phone:718-239-6929
Practice Address - Fax:718-239-8602
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-02
Last Update Date:2012-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY051024-1122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty