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General NPI Number Information
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NPI Number | 1306049366
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Entity Type | Organization
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Legal Business Name | DENTAL PLAZA PA
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Dates
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Enumeration Date | 06/07/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 503 PAULISON AVE
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City | PASSAIC
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State | NJ
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Zip | 07055
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Country | US
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Telephone | 973-471-4500
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Fax | 973-471-4500
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Provider Business Mailing Address
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Address Line | 503 PAULISON AVE
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City | PASSAIC
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State | NJ
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Zip | 07055
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Country | US
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Telephone | 973-471-4500
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Fax | 973-471-8575
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Authorized Official
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Title or Position | PRESIDENT OF DENTAL PLAZA PA
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Name | DR. VINCE F DALESSIO
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Credential | DMD
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Telephone | 973-471-4500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 018013
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 17435
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License Number State | NJ
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Taxonomy #3
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 16958
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License Number State | NJ
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