Provider Demographics
NPI:1770012726
Name:SOUTHWOOD FAMILY DENTAL PC
Entity Type:Organization
Organization Name:SOUTHWOOD FAMILY DENTAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JUNGHWAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SOH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:516-483-9488
Mailing Address - Street 1:50 CLINTON ST STE 100
Mailing Address - Street 2:
Mailing Address - City:HEMPSTEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11550-4201
Mailing Address - Country:US
Mailing Address - Phone:516-483-9488
Mailing Address - Fax:516-489-4853
Practice Address - Street 1:50 CLINTON ST STE 100
Practice Address - Street 2:
Practice Address - City:HEMPSTEAD
Practice Address - State:NY
Practice Address - Zip Code:11550-4201
Practice Address - Country:US
Practice Address - Phone:516-483-9488
Practice Address - Fax:516-489-4853
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-05
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY052909261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental