Healthcare Provider Details

I. General information

NPI: 1972665875
Provider Name (Legal Business Name): BERGEN PERIODONTIC ASSOC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 OLD HOOK ROAD SUITE 104
WESTWOOD NJ
07675
US

IV. Provider business mailing address

333 OLD HOOK ROAD SUITE 104
WESTWOOD NJ
07675
US

V. Phone/Fax

Practice location:
  • Phone: 201-666-2330
  • Fax: 201-666-5043
Mailing address:
  • Phone: 201-666-2330
  • Fax: 201-666-5043

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number22DIO842600
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number StateNJ

VIII. Authorized Official

Name: DR. LIANA BASCEANU
Title or Position: OWNER
Credential: DDS
Phone: 201-666-2330