=====================================================
General NPI Number Information
=====================================================
NPI Number | 1164579934
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AESTHETIC FAMILY DENTISTRY P.A.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/04/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 35 W MAIN ST SUITE # 208
-----------------------------------------------------
City | DENVILLE
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07834-2174
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-627-3617
-----------------------------------------------------
Fax | 973-627-5069
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 35 W MAIN ST SUITE # 208
-----------------------------------------------------
City | DENVILLE
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07834-2174
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-627-3617
-----------------------------------------------------
Fax | 973-627-5069
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRES
-----------------------------------------------------
Name | DR. ALAN B. STEINER
-----------------------------------------------------
Credential | DMD
-----------------------------------------------------
Telephone | 973-627-3617
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 22D101607500
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------