Healthcare Provider Details

I. General information

NPI: 1497685879
Provider Name (Legal Business Name): BERGEN DENTAL AESTHETICS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2026
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7601 BROADWAY
NORTH BERGEN NJ
07047-6589
US

IV. Provider business mailing address

7601 BROADWAY
NORTH BERGEN NJ
07047-6589
US

V. Phone/Fax

Practice location:
  • Phone: 201-869-3107
  • Fax: 201-869-0809
Mailing address:
  • Phone: 201-869-3107
  • Fax: 201-869-0809

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: MS. GABRIELA ABASCAL
Title or Position: OWNER
Credential: DDS
Phone: 201-869-3107