Provider Demographics
NPI:1598252454
Name:HUDSON EMERGENCY DENTAL AND IMPLANT CENTER
Entity Type:Organization
Organization Name:HUDSON EMERGENCY DENTAL AND IMPLANT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HYUK
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:347-501-1110
Mailing Address - Street 1:1160 KENNEDY BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:BAYONNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07002-3128
Mailing Address - Country:US
Mailing Address - Phone:201-471-7777
Mailing Address - Fax:
Practice Address - Street 1:1160 KENNEDY BLVD STE B
Practice Address - Street 2:
Practice Address - City:BAYONNE
Practice Address - State:NJ
Practice Address - Zip Code:07002-3128
Practice Address - Country:US
Practice Address - Phone:201-471-7777
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-17
Last Update Date:2018-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI0236401223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty