Provider Demographics
NPI:1801370366
Name:PALISADES PARK DENTAL P.C.
Entity Type:Organization
Organization Name:PALISADES PARK DENTAL P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MYUNGSOOK
Authorized Official - Middle Name:
Authorized Official - Last Name:CHOI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-321-2354
Mailing Address - Street 1:225 BROAD AVE # 102
Mailing Address - Street 2:
Mailing Address - City:PALISADES PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07650-1588
Mailing Address - Country:US
Mailing Address - Phone:201-461-5580
Mailing Address - Fax:
Practice Address - Street 1:225 BROAD AVE # 102
Practice Address - Street 2:
Practice Address - City:PALISADES PARK
Practice Address - State:NJ
Practice Address - Zip Code:07650-1588
Practice Address - Country:US
Practice Address - Phone:201-461-5580
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-20
Last Update Date:2018-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty