Provider Demographics
NPI:1932328648
Name:PRECISION DENTAL OF ROCKLAND COUNTY, LLC
Entity Type:Organization
Organization Name:PRECISION DENTAL OF ROCKLAND COUNTY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:EUGENE
Authorized Official - Middle Name:
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:842-429-2953
Mailing Address - Street 1:63 NEW MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HAVERSTRAW
Mailing Address - State:NY
Mailing Address - Zip Code:10927-1859
Mailing Address - Country:US
Mailing Address - Phone:845-429-2953
Mailing Address - Fax:
Practice Address - Street 1:63 NEW MAIN ST
Practice Address - Street 2:
Practice Address - City:HAVERSTRAW
Practice Address - State:NY
Practice Address - Zip Code:10927-1859
Practice Address - Country:US
Practice Address - Phone:845-429-2953
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0505771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty