Healthcare Provider Details

I. General information

NPI: 1598923187
Provider Name (Legal Business Name): EASTERN DENTAL OF PARSIPPANY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/30/2008
Last Update Date: 05/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2936 ROUTE 10 WEST
PARSIPPANY NJ
07950-1244
US

IV. Provider business mailing address

2936 ROUTE 10 WEST
PARSIPPANY NJ
07950-1244
US

V. Phone/Fax

Practice location:
  • Phone: 973-292-2550
  • Fax:
Mailing address:
  • Phone: 973-292-2550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number20509
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number10967
License Number StateNJ

VIII. Authorized Official

Name: AARON FEILER
Title or Position: EXECUTIVE DENTAL DIRECTOR
Credential: D.D.S
Phone: 973-292-2550