Provider Demographics
NPI:1720270812
Name:YOUNG DENTAL GROUP
Entity Type:Organization
Organization Name:YOUNG DENTAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:YOUNG HO
Authorized Official - Middle Name:
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:201-224-4440
Mailing Address - Street 1:300 KNICKERBOCKER RD
Mailing Address - Street 2:SUITE #3400
Mailing Address - City:CRESSKILL
Mailing Address - State:NJ
Mailing Address - Zip Code:07626-1350
Mailing Address - Country:US
Mailing Address - Phone:201-227-7440
Mailing Address - Fax:
Practice Address - Street 1:300 KNICKERBOCKER RD
Practice Address - Street 2:SUITE #3400
Practice Address - City:CRESSKILL
Practice Address - State:NJ
Practice Address - Zip Code:07626-1350
Practice Address - Country:US
Practice Address - Phone:201-227-7440
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-13
Last Update Date:2007-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ215111223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty