Bethel Oral Surgery LLC

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

20618 Issued in NJ

Legal business name

BETHEL ORAL SURGERY LLC

Doing business as

Bethel Oral Surgery

Practice address

1319 Anderson Ave
Suite #D
Fort Lee, NJ 07024-1770

Phone

(201) 969-8888

NPI assigned

Sep 21, 2010

Last updated

Sep 21, 2010By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Andrew Kim, D.D.S.NPI 1578517801

Title

Owner

Phone

(201) 969-8888

Specialties & licenses 1

Addresses

Other names 1

• Bethel Oral Surgery Doing business as

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Andrew D Kim, D.D.S.

  • Oral and Maxillofacial Surgery (Dentist)
  • Newark, NJ
  • NPI 1578517801
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1285027200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1285027200000",
    "number": "1780992958",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1319 ANDERSON AVE",
            "address_2": "SUITE #D",
            "city": "FORT LEE",
            "state": "NJ",
            "postal_code": "070241770",
            "telephone_number": "201-969-8888"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1319 ANDERSON AVE",
            "address_2": "SUITE #D",
            "city": "FORT LEE",
            "state": "NJ",
            "postal_code": "070241770",
            "telephone_number": "201-969-8888"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BETHEL ORAL SURGERY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-09-21",
        "last_updated": "2010-09-21",
        "status": "A",
        "authorized_official_last_name": "KIM",
        "authorized_official_first_name": "ANDREW",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "201-969-8888",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "NJ",
            "license": "20618",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bethel Oral Surgery",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Oral and Maxillofacial Surgery (Dentist) in Fort Lee, NJ
• Providers in Fort Lee, NJ by specialty
• Oral and Maxillofacial Surgery (Dentist) in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 21, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.