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General NPI Number Information
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NPI Number | 1639292410
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Entity Type | Organization
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Legal Business Name | LAFAYETTE FAMILY DENTISTRY MGMT INC
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Dates
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Enumeration Date | 04/09/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 540 LAFAYETTE AVENUE
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City | HAWTHORNE
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State | NJ
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Zip | 07506
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Country | US
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Telephone | 973-304-0700
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Fax | 973-304-2013
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Provider Business Mailing Address
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Address Line | 520 SUMMIT AVENUE
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City | HACKENSACK
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State | NJ
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Zip | 07601
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Country | US
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Telephone | 201-488-9030
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Fax | 201-488-9130
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Authorized Official
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Title or Position | GENERAL MANAGER
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Name | MR. DAVID CHERKEZ
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Credential |
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Telephone | 201-488-8866
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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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