Healthcare Provider Details

I. General information

NPI: 1982978227
Provider Name (Legal Business Name): CLIFTON PEDIATRIC DENTAL CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2012
Last Update Date: 03/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 BRIGHTON RD SUITE #105
CLIFTON NJ
07012-1647
US

IV. Provider business mailing address

6 BRIGHTON RD SUITE #105
CLIFTON NJ
07012-1647
US

V. Phone/Fax

Practice location:
  • Phone: 973-473-7377
  • Fax: 973-473-7378
Mailing address:
  • Phone: 973-473-7377
  • Fax: 973-473-7378

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number22DI02433500
License Number StateNJ

VIII. Authorized Official

Name: DR. ARI JONATHAN SUGARMAN
Title or Position: OWNER
Credential: D.M.D.
Phone: 973-473-7377