Healthcare Provider Details

I. General information

NPI: 1134552920
Provider Name (Legal Business Name): MICHAEL STEPHEN DOBLIN D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2013
Last Update Date: 08/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

185 LINDEN STREET
HACKENSACK NJ
07601
US

IV. Provider business mailing address

185 LINDEN STREET
HACKENSACK NJ
07601
US

V. Phone/Fax

Practice location:
  • Phone: 201-396-9338
  • Fax:
Mailing address:
  • Phone: 201-870-3392
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number034419-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number22DI01219000
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number12190
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: