Healthcare Provider Details

I. General information

NPI: 1376586032
Provider Name (Legal Business Name): FLANDERS PEDIATRIC DENTISTRY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 ROUTE 206
FLANDERS NJ
07836-9262
US

IV. Provider business mailing address

230 ROUTE 206
FLANDERS NJ
07836-9189
US

V. Phone/Fax

Practice location:
  • Phone: 973-927-2260
  • Fax: 973-927-8356
Mailing address:
  • Phone: 973-927-2260
  • Fax: 973-927-8356

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number22DI01065800
License Number StateNJ

VIII. Authorized Official

Name: DR. EDWARD M. SONNENBERG
Title or Position: PRESIDENT
Credential: DDS
Phone: 973-927-2260