Provider Demographics
NPI:1861848079
Name:HI DENTAL, PLLC
Entity Type:Organization
Organization Name:HI DENTAL, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HYESUNG
Authorized Official - Middle Name:
Authorized Official - Last Name:IM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:516-586-8877
Mailing Address - Street 1:154 S FRONT ST
Mailing Address - Street 2:
Mailing Address - City:FARMINGDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11735-2637
Mailing Address - Country:US
Mailing Address - Phone:516-586-8877
Mailing Address - Fax:516-586-8878
Practice Address - Street 1:154 S FRONT ST
Practice Address - Street 2:
Practice Address - City:FARMINGDALE
Practice Address - State:NY
Practice Address - Zip Code:11735-2637
Practice Address - Country:US
Practice Address - Phone:516-586-8877
Practice Address - Fax:516-586-8878
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-05
Last Update Date:2016-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0539151122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty