Healthcare Provider Details

I. General information

NPI: 1063402683
Provider Name (Legal Business Name): KENNEDY DENTAL CENTER PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2005
Last Update Date: 01/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3196 KENNEDY BLVD 3RD FLOOR
UNION CITY NJ
07087-2436
US

IV. Provider business mailing address

3196 KENNEDY BLVD 3RD FLOOR
UNION CITY NJ
07087-2436
US

V. Phone/Fax

Practice location:
  • Phone: 201-330-8400
  • Fax: 201-330-0173
Mailing address:
  • Phone: 201-330-8400
  • Fax: 201-330-0173

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDI020821
License Number StateNJ

VIII. Authorized Official

Name: DR. NAYNESH SAVALIA
Title or Position: OWNER PRESIDENT
Credential: DMD
Phone: 201-330-8400