Healthcare Provider Details

I. General information

NPI: 1558903955
Provider Name (Legal Business Name): ANDERSON DENTAL CENTER HACKENSACK LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2019
Last Update Date: 12/16/2019
Certification Date: 12/16/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 ANDERSON ST
HACKENSACK NJ
07601-4508
US

IV. Provider business mailing address

15 ANDERSON ST
HACKENSACK NJ
07601-4508
US

V. Phone/Fax

Practice location:
  • Phone: 201-546-7435
  • Fax:
Mailing address:
  • Phone: 201-546-7435
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VII. Legacy identifiers

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

VIII. Authorized Official

Name: MR. MOHAMMED IBREHIM EL-SAMNA
Title or Position: PARTNER
Credential:
Phone: 201-546-7435