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General NPI Number Information
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NPI Number | 1154574465
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Entity Type | Organization
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Legal Business Name | CENTER FOR FAMILY DENTISTRY
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Dates
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Enumeration Date | 10/30/2008
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Last Update Date | 11/06/2008
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Provider Practice Location Address
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Address Line | 1187 CLINTON AVE
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City | IRVINGTON
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State | NJ
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Zip | 07111
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Country | US
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Telephone | 973-375-0400
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Fax |
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Provider Business Mailing Address
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Address Line | 1187 CLINTON AVE
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City | IRVINGTON
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State | NJ
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Zip | 07111
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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 | DMD
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Name | FARIBA SHARIFAN
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Credential |
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Telephone | 973-375-0400
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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 | DI020295
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License Number State | NJ
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