Healthcare Provider Details

I. General information

NPI: 1215181755
Provider Name (Legal Business Name): INFINITE ENDODONTICS NORTH JERSEY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/11/2008
Last Update Date: 12/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1219 MAIN AVENUE
CLIFTON NJ
07011
US

IV. Provider business mailing address

401 COMMERCE DRIVE
FORT WASHINGTON PA
19034
US

V. Phone/Fax

Practice location:
  • Phone: 973-473-0900
  • Fax: 973-772-3989
Mailing address:
  • Phone: 215-646-6188
  • Fax: 215-646-6369

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number22DI02071600
License Number StateNJ

VIII. Authorized Official

Name: SPENCER CARL SAINT CYR
Title or Position: OWNER
Credential: DMD
Phone: 973-772-3989