Healthcare Provider Details

I. General information

NPI: 1386984243
Provider Name (Legal Business Name): SUMMIT DENTAL GROUP RIVERDALE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2013
Last Update Date: 02/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

92 STATE RT 23
RIVERDALE NJ
07457-1203
US

IV. Provider business mailing address

860 MEADOW LN
FRANKLIN LAKES NJ
07417-1112
US

V. Phone/Fax

Practice location:
  • Phone: 201-891-7400
  • Fax:
Mailing address:
  • Phone: 973-342-1233
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number22DI02140400
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number22DI02152600
License Number StateNJ

VIII. Authorized Official

Name: DR. ROBERT LORINO
Title or Position: MEMBER/OWNER
Credential: D.M.D.
Phone: 973-342-1233