Provider Demographics
NPI:1568159614
Name:HACKENSACK EMERGENCY DENTAL AND IMPLANT CENTER PC
Entity Type:Organization
Organization Name:HACKENSACK EMERGENCY DENTAL AND IMPLANT CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:HYUK
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:201-471-7777
Mailing Address - Street 1:35 PANGBORN PL
Mailing Address - Street 2:
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-4560
Mailing Address - Country:US
Mailing Address - Phone:551-795-4671
Mailing Address - Fax:
Practice Address - Street 1:35 PANGBORN PL
Practice Address - Street 2:
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-4560
Practice Address - Country:US
Practice Address - Phone:551-795-4671
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-19
Last Update Date:2023-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty