Healthcare Provider Details

I. General information

NPI: 1740531029
Provider Name (Legal Business Name): FINE FAMILY DENTAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2012
Last Update Date: 09/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 E PALISADE AVE SUITE 11-C
ENGLEWOOD NJ
07631-3169
US

IV. Provider business mailing address

64 WOODLAND DR
WOODLAND PARK NJ
07424-3707
US

V. Phone/Fax

Practice location:
  • Phone: 201-569-9393
  • Fax:
Mailing address:
  • Phone: 973-830-0814
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number22DI02318500
License Number StateNJ

VIII. Authorized Official

Name: DR. CRAIG IRVIN FINE
Title or Position: PRESIDENT
Credential: D.M.D.
Phone: 201-569-9393