Healthcare Provider Details

I. General information

NPI: 1073279832
Provider Name (Legal Business Name): A&L DENTAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2021
Last Update Date: 11/16/2021
Certification Date: 11/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39 E PROSPECT ST
WALDWICK NJ
07463-2009
US

IV. Provider business mailing address

39 E PROSPECT ST
WALDWICK NJ
07463-2009
US

V. Phone/Fax

Practice location:
  • Phone: 201-652-5499
  • Fax:
Mailing address:
  • Phone: 201-652-5499
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number
License Number State

VIII. Authorized Official

Name: JOSEPH ALBANESE
Title or Position: PARTIAL OWNER
Credential: DMD
Phone: 718-987-6543