Healthcare Provider Details

I. General information

NPI: 1780783548
Provider Name (Legal Business Name): ULTIMATE DENTAL OF NORTH BERGEN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8135 KENNEDY BLVD
NORTH BERGEN NJ
07047-4243
US

IV. Provider business mailing address

8135 KENNEDY BLVD
NORTH BERGEN NJ
07047-4243
US

V. Phone/Fax

Practice location:
  • Phone: 201-869-5156
  • Fax: 201-869-3891
Mailing address:
  • Phone: 201-869-5156
  • Fax: 201-869-3891

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberD119389
License Number StateNJ

VIII. Authorized Official

Name: DR. VINCENT HECTOR ALVAREZ
Title or Position: PRES
Credential: DMD
Phone: 201-869-5156