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General NPI Number Information
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NPI Number | 1679919252
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Entity Type | Organization
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Legal Business Name | PATERSON FAMILY DENTAL
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Dates
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Enumeration Date | 05/22/2013
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Last Update Date | 05/22/2013
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Provider Practice Location Address
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Address Line | 1020 MAIN ST
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City | PATERSON
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State | NJ
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Zip | 07503-2244
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Country | US
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Telephone | 973-225-9975
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Fax |
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Provider Business Mailing Address
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Address Line | 1020 MAIN ST
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City | PATERSON
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State | NJ
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Zip | 07503-2244
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | PETER FUENTES
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Credential | DMD
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Telephone | 973-225-9975
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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 | 22907
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License Number State | NJ
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