Healthcare Provider Details

I. General information

NPI: 1114852779
Provider Name (Legal Business Name): DENTIQ OF ENGLEWOOD CLIFFS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2026
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 CHARLOTTE PL
ENGLEWOOD CLIFFS NJ
07632-2613
US

IV. Provider business mailing address

10 EUGENE CIR
LINCOLN PARK NJ
07035-1502
US

V. Phone/Fax

Practice location:
  • Phone: 201-431-9753
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. DOREEN MARIO CHARLY
Title or Position: GENERAL DENTIST
Credential: DMD
Phone: 832-350-2063