Provider Demographics
NPI:1861896862
Name:NORTHAMPTON FAMILY DENTISTRY PC
Entity type:Organization
Organization Name:NORTHAMPTON FAMILY DENTISTRY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHULHWAN
Authorized Official - Middle Name:JAKE
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:617-869-0000
Mailing Address - Street 1:69 BRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:NORTHAMPTON
Mailing Address - State:MA
Mailing Address - Zip Code:01060-2402
Mailing Address - Country:US
Mailing Address - Phone:413-584-1722
Mailing Address - Fax:413-584-5835
Practice Address - Street 1:69 BRIDGE ST
Practice Address - Street 2:
Practice Address - City:NORTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01060-2402
Practice Address - Country:US
Practice Address - Phone:413-584-1722
Practice Address - Fax:413-584-5835
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-20
Last Update Date:2014-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN22064122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty