=====================================================
General NPI Number Information
=====================================================
NPI Number | 1104229384
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | A P S DENTAL CENTER, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/02/2014
-----------------------------------------------------
Last Update Date | 10/02/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 24 W PRICE ST
-----------------------------------------------------
City | LINDEN
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07036-4257
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 908-925-3535
-----------------------------------------------------
Fax | 908-925-7131
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 24 W PRICE ST
-----------------------------------------------------
City | LINDEN
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07036-4257
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 908-925-3535
-----------------------------------------------------
Fax | 908-925-7131
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DENTIST
-----------------------------------------------------
Name | CHARANJIT KAUR SANDHU
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 908-925-3535
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | DI17853
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------