Provider Demographics
NPI:1740593177
Name:P&S DENTAL LLC
Entity Type:Organization
Organization Name:P&S DENTAL LLC
Other - Org Name:JERSEY CITY DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:SANG HOON
Authorized Official - Middle Name:
Authorized Official - Last Name:PAEK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:917-583-6646
Mailing Address - Street 1:162 NEWARK AVE
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07302-2814
Mailing Address - Country:US
Mailing Address - Phone:201-434-0919
Mailing Address - Fax:201-434-1453
Practice Address - Street 1:162 NEWARK AVE
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07302-2814
Practice Address - Country:US
Practice Address - Phone:201-434-0919
Practice Address - Fax:201-434-1453
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-14
Last Update Date:2010-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ2377100122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0229296Medicaid
NJ8983909Medicaid
NJ0229288Medicaid
NJ0218162Medicaid