Provider Demographics
NPI:1457923872
Name:ETEN DENTAL PLLC
Entity type:Organization
Organization Name:ETEN DENTAL PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EJU
Authorized Official - Middle Name:
Authorized Official - Last Name:HWANG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:718-423-1010
Mailing Address - Street 1:46 WINTHROP DR
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11797-1315
Mailing Address - Country:US
Mailing Address - Phone:516-584-6528
Mailing Address - Fax:
Practice Address - Street 1:21814 NORTHERN BLVD STE 104
Practice Address - Street 2:
Practice Address - City:BAYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11361-3580
Practice Address - Country:US
Practice Address - Phone:184-231-0107
Practice Address - Fax:718-423-1011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-14
Last Update Date:2021-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental