Healthcare Provider Details

I. General information

NPI: 1790878080
Provider Name (Legal Business Name): EAST MADISON DENTAL CORP., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2006
Last Update Date: 08/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 PIERMONT RD
TENAFLY NJ
07670
US

IV. Provider business mailing address

79 E MADISON AVE
DUMONT NJ
07628-2417
US

V. Phone/Fax

Practice location:
  • Phone: 201-501-8282
  • Fax: 201-501-8380
Mailing address:
  • Phone: 201-501-8282
  • Fax: 201-501-8380

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number22DI02460200
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number22DI01950206
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number22DI02660802
License Number StateNJ
# 4
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number22DI01938209
License Number StateNJ
# 5
Primary TaxonomyN
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number22DI02277300
License Number StateNJ
# 6
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number22DI02193003
License Number StateNJ
# 7
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number22DI01938000
License Number StateNJ

VIII. Authorized Official

Name: DR. NARPAT S. JAIN
Title or Position: PRESIDENT
Credential: DMD
Phone: 201-501-8282