MEDICARE: ALL QUALITY DENTAL LLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	22D102207500	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1578788576
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALL QUALITY DENTAL LLP

Provider Business Mailing Address
First Line	:	65 JEFFERSON AVE
Second Line	:
City	:	ELIZABETH
State	:	NJ
Zip	:	07201-2474
Country	:	US
Telephone Number	:	908-527-8688
Fax Number	:	908-527-9399

Provider Business Practice Location Address
First Line	:	65 JEFFERSON AVE
Second Line	:
City	:	ELIZABETH
State	:	NJ
Zip	:	07201-2474
Country	:	US
Telephone Number	:	908-527-8688
Fax Number	:	908-527-9399

Authorized Official
Title or Position	:	DDS GENERAL DENTIST
Name	:	GRIGORIY YUSUPOV
Credential	:	DDS
Telephone Number	:	908-527-8688

Provider Enumeration Date	:	04/16/2007
Last Update Date	:	08/22/2020

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