Healthcare Provider Details

I. General information

NPI: 1942263124
Provider Name (Legal Business Name): CLIFTON ENDODONTICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 CLIFTON AVE SUITE 1A
CLIFTON NJ
07013-3586
US

IV. Provider business mailing address

1001 CLIFTON AVE SUITE 1A
CLIFTON NJ
07013-3586
US

V. Phone/Fax

Practice location:
  • Phone: 973-773-6050
  • Fax: 973-773-3520
Mailing address:
  • Phone: 973-773-6050
  • Fax: 973-773-3520

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number13429
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number10997
License Number StateNJ

VIII. Authorized Official

Name: MS. GRACE SCHLEMM
Title or Position: OFFICE MANAGER
Credential:
Phone: 973-773-6050