1316150527 NPI number — ALLCARE DENTAL & DENTURES OF OHIO - BATES

Table of content: DR. CHRISTOPHER YOON KONG M.D. (NPI 1285019687)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316150527 NPI number — ALLCARE DENTAL & DENTURES OF OHIO - BATES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALLCARE DENTAL & DENTURES OF OHIO - BATES
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1316150527
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/11/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 369
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CLARENCE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14031-0369
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
716-204-4999
Provider Business Mailing Address Fax Number:
716-632-2963

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7697 MENTOR AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MENTOR
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44060-5540
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
440-975-0612
Provider Business Practice Location Address Fax Number:
440-975-9865
Provider Enumeration Date:
05/07/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BATES
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
S
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
716-622-1563

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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