=====================================================
General NPI Number Information
=====================================================
NPI Number | 1205959103
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DENTAL ASSOCIATES OF DENVILLE, P.A.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/08/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 111 BLOOMFIELD AVE
-----------------------------------------------------
City | DENVILLE
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07834-2701
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-627-6079
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 111 BLOOMFIELD AVE
-----------------------------------------------------
City | DENVILLE
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07834-2701
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-627-6079
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. LEWIS EDWARD FIGATNER
-----------------------------------------------------
Credential | D.D.S.
-----------------------------------------------------
Telephone | 973-627-6053
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | DI10985
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------