Healthcare Provider Details

I. General information

NPI: 1720237092
Provider Name (Legal Business Name): IN NETWORK DENTAL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2008
Last Update Date: 08/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

187 CHESTNUT ST
NUTLEY NJ
07110-2311
US

IV. Provider business mailing address

187 CHESTNUT ST
NUTLEY NJ
07110-2311
US

V. Phone/Fax

Practice location:
  • Phone: 973-661-5039
  • Fax: 973-661-0950
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code305R00000X
TaxonomyPreferred Provider Organization
License Number22DI02377000
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. KENNETH FEILER
Title or Position: OWNER
Credential: D.M.D.
Phone: 973-661-5039