Healthcare Provider Details

I. General information

NPI: 1831254291
Provider Name (Legal Business Name): JOHN PETER MACLAREN D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

70 ANDERSON ST
HACKENSACK NJ
07601-4412
US

IV. Provider business mailing address

3 WOODLAND CT
WAYNE NJ
07470-3858
US

V. Phone/Fax

Practice location:
  • Phone: 201-487-8666
  • Fax:
Mailing address:
  • Phone: 973-628-8314
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number9546
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: