Provider Demographics
NPI:1508754102
Name:MOUNT KISCO DENTISTRY
Entity type:Organization
Organization Name:MOUNT KISCO DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BYUNG CHUL
Authorized Official - Middle Name:
Authorized Official - Last Name:PARK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:914-666-5225
Mailing Address - Street 1:344 E MAIN ST STE 407
Mailing Address - Street 2:
Mailing Address - City:MOUNT KISCO
Mailing Address - State:NY
Mailing Address - Zip Code:10549-3036
Mailing Address - Country:US
Mailing Address - Phone:914-666-5225
Mailing Address - Fax:
Practice Address - Street 1:344 E MAIN ST STE 407
Practice Address - Street 2:
Practice Address - City:MOUNT KISCO
Practice Address - State:NY
Practice Address - Zip Code:10549-3036
Practice Address - Country:US
Practice Address - Phone:914-666-5225
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-24
Last Update Date:2025-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental