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General NPI Number Information
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NPI Number | 1538263603
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Entity Type | Organization
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Legal Business Name | ELIZABETH AVENUE DENTAL CTR
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Dates
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Enumeration Date | 09/11/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 627 ELIZABETH AVENUE
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City | ELIZABETH
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State | NJ
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Zip | 07206
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Country | US
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Telephone | 908-354-0030
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Fax | 908-354-4029
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Provider Business Mailing Address
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Address Line | 627 ELIZABETH AVENUE
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City | ELIZABETH
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State | NJ
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Zip | 07206
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Country | US
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Telephone | 908-354-0030
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Fax | 908-354-4029
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Authorized Official
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Title or Position | PRESIDENT OF CORPORATION
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Name | DR. MEHMET S DICKENGIL
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Credential | DDS
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Telephone | 908-354-0030
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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 | DI15381
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License Number State | NJ
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