Healthcare Provider Details

I. General information

NPI: 1760830293
Provider Name (Legal Business Name): GEORGE XENAKIS, DDS, PALISADES PARK, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2016
Last Update Date: 05/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

946 MAIN ST
HACKENSACK NJ
07601-5136
US

IV. Provider business mailing address

946 MAIN ST
HACKENSACK NJ
07601-5136
US

V. Phone/Fax

Practice location:
  • Phone: 201-464-4783
  • Fax: 844-631-0047
Mailing address:
  • Phone: 201-464-4783
  • Fax: 844-631-0047

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number22DI01715600
License Number StateNJ

VII. Legacy identifiers

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

VIII. Authorized Official

Name: DR. GEORGE XENAKIS
Title or Position: OWNER
Credential: D.D.S
Phone: 212-643-0927