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General NPI Number Information
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NPI Number | 1407391097
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Entity Type | Organization
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Legal Business Name | PARK DENTAL ASSOCIATES, INC
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Dates
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Enumeration Date | 01/05/2017
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Last Update Date | 01/05/2017
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Provider Practice Location Address
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Address Line | 560 BERGEN BLVD
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City | RIDGEFIELD
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State | NJ
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Zip | 07657-2024
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Country | US
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Telephone | 201-945-4477
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Fax | 201-945-5233
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Provider Business Mailing Address
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Address Line | 560 BERGEN BLVD
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City | RIDGEFIELD
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State | NJ
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Zip | 07657-2024
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Country | US
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Telephone | 201-945-4477
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Fax | 201-945-5233
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ALICE SARAYDARIAN
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Credential |
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Telephone | 201-945-4411
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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 | 22DI01668000
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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 | 22DI01728600
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License Number State | NJ
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