Provider Demographics
NPI:1780072165
Name:NEW ROCHELLE KIDS DENTAL
Entity type:Organization
Organization Name:NEW ROCHELLE KIDS DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MOONSUN
Authorized Official - Middle Name:
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:914-632-2800
Mailing Address - Street 1:77 QUAKER RIDGE RD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:NEW ROCHELLE
Mailing Address - State:NY
Mailing Address - Zip Code:10804-2808
Mailing Address - Country:US
Mailing Address - Phone:914-632-2800
Mailing Address - Fax:914-560-2075
Practice Address - Street 1:77 QUAKER RIDGE RD
Practice Address - Street 2:SUITE 210
Practice Address - City:NEW ROCHELLE
Practice Address - State:NY
Practice Address - Zip Code:10804-2808
Practice Address - Country:US
Practice Address - Phone:914-632-2800
Practice Address - Fax:914-560-2075
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-07
Last Update Date:2015-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0498571223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty