Provider Demographics
NPI:1295505246
Name:KENT DENTISTRY & IMPLANTS
Entity type:Organization
Organization Name:KENT DENTISTRY & IMPLANTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:GI TAE
Authorized Official - Middle Name:
Authorized Official - Last Name:KWON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:201-707-4661
Mailing Address - Street 1:70 MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:CT
Mailing Address - Zip Code:06757-1721
Mailing Address - Country:US
Mailing Address - Phone:860-927-3577
Mailing Address - Fax:
Practice Address - Street 1:70 MAPLE ST
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:CT
Practice Address - Zip Code:06757-1721
Practice Address - Country:US
Practice Address - Phone:860-927-3577
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-02
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental