Healthcare Provider Details

I. General information

NPI: 1871075796
Provider Name (Legal Business Name): MASTER DENTISTRY CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2018
Last Update Date: 09/14/2022
Certification Date: 09/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8412 KENNEDY BLVD
NORTH BERGEN NJ
07047-4265
US

IV. Provider business mailing address

8412 KENNEDY BLVD
NORTH BERGEN NJ
07047-4265
US

V. Phone/Fax

Practice location:
  • Phone: 201-758-7834
  • Fax: 201-758-7837
Mailing address:
  • Phone: 201-758-7834
  • Fax: 201-758-7837

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QS0112X
TaxonomyOral and Maxillofacial Surgery Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: RAIF R WADI
Title or Position: OWNER
Credential:
Phone: 210-861-9440