Healthcare Provider Details

I. General information

NPI: 1184000457
Provider Name (Legal Business Name): CHILDREN'S DENTAL HEALTH ASSOCIATES OF ROSELLE P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2015
Last Update Date: 08/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2209 WOOD AVE
ROSELLE NJ
07203-2930
US

IV. Provider business mailing address

2209 WOOD AVE
ROSELLE NJ
07203-2930
US

V. Phone/Fax

Practice location:
  • Phone: 908-245-5556
  • Fax:
Mailing address:
  • Phone: 908-245-5556
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number22DI02315100
License Number StateNJ

VIII. Authorized Official

Name: DR. DANIEL ALLEN
Title or Position: OFFICER
Credential: D.D.S.
Phone: 908-245-5556