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General NPI Number Information
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NPI Number | 1447534755
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Entity Type | Organization
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Legal Business Name | ADVANCED DENTAL CARE P.C
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Dates
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Enumeration Date | 10/05/2011
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Last Update Date | 10/05/2011
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Provider Practice Location Address
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Address Line | 1212 RAYMOND BLVD
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City | NEWARK
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State | NJ
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Zip | 07102
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Country | US
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Telephone | 973-645-0200
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Fax |
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Provider Business Mailing Address
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Address Line | 1212 RAYMOND BLVD
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City | NEWARK
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State | NJ
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Zip | 07102
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Country | US
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Telephone | 973-645-0200
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | INESSA ALIEVA
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Credential |
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Telephone | 973-645-0200
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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 | 220102207500
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License Number State | NJ
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