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General NPI Number Information
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NPI Number | 1487635967
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Entity Type | Organization
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Legal Business Name | TOWER PLAZA DENTISTRY PC
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Dates
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Enumeration Date | 11/10/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 4100 PARK AVE
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City | WEEHAWKEN
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State | NJ
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Zip | 07086
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Country | US
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Telephone | 201-348-1616
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Fax | 201-348-4877
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Provider Business Mailing Address
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Address Line | 4100 PARK AVE
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City | WEEHAWKEN
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State | NJ
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Zip | 07086
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Country | US
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Telephone | 201-348-1616
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Fax | 201-348-4877
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Authorized Official
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Title or Position | OWNER
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Name | LENA KHAYLOMSKY
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Credential | DMD
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Telephone | 201-348-1616
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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 | 22424
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License Number State | NJ
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