Provider Demographics
NPI:1487498358
Name:CONCIERGE DENTAL LOFT P.C.
Entity type:Organization
Organization Name:CONCIERGE DENTAL LOFT P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:DR
Authorized Official - First Name:YOHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:917-868-1552
Mailing Address - Street 1:350 W 71ST ST APT 6A
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-3596
Mailing Address - Country:US
Mailing Address - Phone:215-796-8347
Mailing Address - Fax:646-650-2700
Practice Address - Street 1:26 BROADWAY STE 1303
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10004-1822
Practice Address - Country:US
Practice Address - Phone:917-868-1552
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-24
Last Update Date:2024-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty