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General NPI Number Information
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NPI Number | 1003230293
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Entity Type | Organization
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Legal Business Name | BLOOMFIELD DENTAL DESIGNS
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Dates
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Enumeration Date | 02/10/2014
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Last Update Date | 02/10/2014
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Provider Practice Location Address
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Address Line | 10 WASHINGTON ST
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City | BLOOMFIELD
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State | NJ
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Zip | 07003-3412
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Country | US
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Telephone | 973-743-3930
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Fax |
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Provider Business Mailing Address
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Address Line | 20 MOUNT VERNON SQ
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City | VERONA
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State | NJ
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Zip | 07044-2924
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Country | US
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Telephone | 201-724-2895
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Fax |
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Authorized Official
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Title or Position | DDS
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Name | BORIS ALVAREZ
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Credential |
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Telephone | 201-724-2895
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 22DI02366100
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License Number State | NJ
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