Healthcare Provider Details

I. General information

NPI: 1215737333
Provider Name (Legal Business Name): PEDIATRIC DENTISTRY ASLEEP OF NEW JERSEY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/17/2025
Last Update Date: 03/17/2025
Certification Date: 03/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 PROSPECT AVE
HACKENSACK NJ
07601-1915
US

IV. Provider business mailing address

500 N LEWIS RUN RD STE 215A
WEST MIFFLIN PA
15122-3009
US

V. Phone/Fax

Practice location:
  • Phone: 412-672-4077
  • Fax:
Mailing address:
  • Phone: 857-200-3312
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
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: DR. JOHNNY JOSEPH
Title or Position: PEDIATRIC DENTIST OWNER
Credential: DMD
Phone: 572-003-3128