Provider Demographics
NPI:1124370374
Name:HOLLYWOOD DENTISTRY L.L.C
Entity type:Organization
Organization Name:HOLLYWOOD DENTISTRY L.L.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:YOUNG
Authorized Official - Last Name:KEH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:973-424-0040
Mailing Address - Street 1:23 BRANFORD PLACE
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07102
Mailing Address - Country:US
Mailing Address - Phone:973-424-0040
Mailing Address - Fax:973-424-0089
Practice Address - Street 1:23 BRANFORD PLACE
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07102
Practice Address - Country:US
Practice Address - Phone:973-424-0040
Practice Address - Fax:973-424-0089
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-12
Last Update Date:2012-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI021401001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty