=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376092049
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PAARTH DENTAL PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/23/2016
-----------------------------------------------------
Last Update Date | 09/23/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 119-137 CLIFFORD STREET
-----------------------------------------------------
City | NEWARK
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07105
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-465-7737
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 119 CLIFFORD STREET NUM 137
-----------------------------------------------------
City | NEWARK
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07105
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-465-7737
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DENTIST
-----------------------------------------------------
Name | LIYA MOHAMMED
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 973-465-7737
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 22DI102564300
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------