Provider Demographics
NPI:1750041273
Name:COLUMBIA BROTHERS DENTAL GROUP
Entity Type:Organization
Organization Name:COLUMBIA BROTHERS DENTAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOON SEOK
Authorized Official - Middle Name:
Authorized Official - Last Name:CHO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:201-661-4665
Mailing Address - Street 1:410 SPOTSWOOD ENGLISHTOWN RD
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:NJ
Mailing Address - Zip Code:08831-8615
Mailing Address - Country:US
Mailing Address - Phone:732-251-5252
Mailing Address - Fax:
Practice Address - Street 1:410 SPOTSWOOD ENGLISHTOWN RD
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NJ
Practice Address - Zip Code:08831-8615
Practice Address - Country:US
Practice Address - Phone:732-251-5252
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-23
Last Update Date:2021-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty