Healthcare Provider Details

I. General information

NPI: 1639132434
Provider Name (Legal Business Name): FAMILY DENTAL ASSOCIATION OF BROOKDALE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

988 BROAD ST
BLOOMFIELD NJ
07003-2806
US

IV. Provider business mailing address

988 BROAD ST
BLOOMFIELD NJ
07003-2806
US

V. Phone/Fax

Practice location:
  • Phone: 973-338-6667
  • Fax:
Mailing address:
  • Phone: 973-338-6667
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number16375
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. ALAN S. KAPLAN
Title or Position: OWNER
Credential: DDS
Phone: 973-338-6667