Healthcare Provider Details

I. General information

NPI: 1861614927
Provider Name (Legal Business Name): ASSOCIATES IN IMPLANT AND COSMETIC DENTISTRY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2007
Last Update Date: 02/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

545 ROUTE 17 S # 2007
RIDGEWOOD NJ
07450
US

IV. Provider business mailing address

545 ROUTE 17 S # 2007
RIDGEWOOD NJ
07450
US

V. Phone/Fax

Practice location:
  • Phone: 201-447-9700
  • Fax: 201-447-4099
Mailing address:
  • Phone: 201-447-9700
  • Fax: 201-447-4099

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number15362
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number08867
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number12955
License Number StateNJ

VIII. Authorized Official

Name: ALBERT J KURPIS
Title or Position: OWNER
Credential: DDS
Phone: 201-447-9700