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General NPI Number Information
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NPI Number | 1619120664
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Entity Type | Organization
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Legal Business Name | ADVANCED DENTAL LLC
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Dates
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Enumeration Date | 11/03/2008
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Last Update Date | 03/21/2016
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Provider Practice Location Address
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Address Line | 490 E MAIN ST
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City | DENVILLE
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State | NJ
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Zip | 07834-2484
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Country | US
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Telephone | 973-586-4444
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Fax | 973-586-4455
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Provider Business Mailing Address
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Address Line | 490 E MAIN ST SUITE 103
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City | DENVILLE
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State | NJ
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Zip | 07834-2484
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Country | US
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Telephone | 973-586-4444
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Fax | 973-586-4455
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Authorized Official
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Title or Position | PERIODONTIST/OWNER
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Name | DR. PETER D TSAMBAZIS
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Credential | DMD
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Telephone | 973-586-4444
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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 | 18218
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 18218
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License Number State | NJ
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