Provider Demographics
NPI:1174892657
Name:UNITED DENTAL CORPORATION
Entity type:Organization
Organization Name:UNITED DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO, CFO, & SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:JEONG
Authorized Official - Middle Name:HOON
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-636-0088
Mailing Address - Street 1:10130 GARDEN GROVE BLVD STE 201
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92844-1684
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10130 GARDEN GROVE BLVD STE 201
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92844-1684
Practice Address - Country:US
Practice Address - Phone:714-636-0088
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-29
Last Update Date:2011-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
No126800000XDental ProvidersDental AssistantGroup - Multi-Specialty