| Closter Dental Pc | |
|
570 Piermont Rd #c1 Closter NJ 07624 | |
| (201) 666-2828 | |
| (201) 750-2314 |
| Full Name | Closter Dental Pc |
|---|---|
| Speciality | Dentist |
| Location | 570 Piermont Rd, Closter, New Jersey |
| Authorized Official Name and Position | Sung Rae Kim (PRESIDENT) |
| Authorized Official Contact | 2016662828 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Closter Dental Pc 570 Piermont Rd #c1 Closter NJ 07624 Ph: (201) 666-2828 | Closter Dental Pc 570 Piermont Rd #c1 Closter NJ 07624 Ph: (201) 666-2828 |
| NPI Number | 1578677092 |
|---|---|
| Provider Enumeration Date | 08/19/2006 |
| Last Update Date | 08/22/2020 |
| Medicare PECOS PAC ID | 1456784594 |
|---|---|
| Medicare Enrollment ID | O20191204001536 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1578677092 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0700X | Dentist - Prosthodontics | DI19751 (New Jersey) | Primary |
| Provider Name | Sung Rae Kim |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1679995955 PECOS PAC ID: 7618300757 Enrollment ID: I20191204001670 |
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