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General NPI Number Information
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NPI Number | 1447959044
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Entity Type | Organization
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Legal Business Name | ENGLEWOOD DENTIST LLC
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Dates
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Enumeration Date | 03/02/2023
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Last Update Date | 03/02/2023
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Provider Practice Location Address
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Address Line | 115 GRAND AVE
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City | ENGLEWOOD
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State | NJ
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Zip | 07631-3654
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Country | US
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Telephone | 201-304-7077
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Fax | 201-304-7077
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Provider Business Mailing Address
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Address Line | 115 GRAND AVE
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City | ENGLEWOOD
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State | NJ
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Zip | 07631-3654
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Country | US
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Telephone | 201-304-7077
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Fax | 201-304-7077
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Authorized Official
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Title or Position | OWNER
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Name | DR. DAVID HANNA
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Credential | DMD
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Telephone | 551-200-1939
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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 |
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License Number State |
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