Healthcare Provider Details

I. General information

NPI: 1083518765
Provider Name (Legal Business Name): POWERVILLE FAMILY DENTAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2026
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 ELCOCK AVE
BOONTON NJ
07005-1112
US

IV. Provider business mailing address

104 ELCOCK AVE
BOONTON NJ
07005-1112
US

V. Phone/Fax

Practice location:
  • Phone: 973-334-8451
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. ROBERT CABANA
Title or Position: OWNER
Credential: DDS
Phone: 201-400-2030