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General NPI Number Information
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NPI Number | 1013833284
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Entity Type | Organization
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Legal Business Name | EASTERN DENTAL OF ELMWOOD PARK, LLC
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Dates
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Enumeration Date | 06/24/2026
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Last Update Date | 06/24/2026
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Provider Practice Location Address
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Address Line | 100 BROADWAY
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City | ELMWOOD PARK
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State | NJ
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Zip | 07407-3025
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Country | US
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Telephone | 732-750-0707
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Fax |
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Provider Business Mailing Address
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Address Line | 510 THORNALL ST STE 230
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City | EDISON
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State | NJ
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Zip | 08837-2204
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | GENERAL COUNSEL
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Name | ALEX PETRIK
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Credential |
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Telephone | 248-756-6738
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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