Organization
GREENBURGH KIDS DENTAL, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JENNIFER KIM DDS (OWNER)
(562) 405-2001
Entity
Organization
Contact information
Practice address
99 FIELDSTONE DR, HARTSDALE, NY 10530-1564
(914) 997-8820
(914) 997-9627
Mailing address
99 FIELDSTONE DR, HARTSDALE, NY 10530-1564
(914) 997-8820
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03260895
—
NY
Enumeration date
08/02/2019
Last updated
08/02/2019
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