Healthcare Provider Details

I. General information

NPI: 1619160264
Provider Name (Legal Business Name): ALL FAMILY DENTAL CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2007
Last Update Date: 08/27/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 US HIGHWAY 46
RIDGEFIELD PARK NJ
07660-1948
US

IV. Provider business mailing address

45 US HIGHWAY 46
RIDGEFIELD PARK NJ
07660-1948
US

V. Phone/Fax

Practice location:
  • Phone: 201-440-2100
  • Fax:
Mailing address:
  • Phone: 201-440-2100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDI18910
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License NumberDI22492
License Number StateNJ

VIII. Authorized Official

Name: VLADIMIR MESKIN
Title or Position: DENTIST/OWNER
Credential:
Phone: 201-440-2100