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General NPI Number Information
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NPI Number | 1730201062
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Entity Type | Organization
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Legal Business Name | TENAFLY ORTHODONTIC ASSOCIATES LLC
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Dates
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Enumeration Date | 04/06/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 111 DEAN DRIVE
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City | TENAFLY
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State | NJ
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Zip | 07670
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Country | US
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Telephone | 201-569-2112
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Fax | 201-569-7605
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Provider Business Mailing Address
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Address Line | 111 DEAN DRIVE
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City | TENAFLY
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State | NJ
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Zip | 07670
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Country | US
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Telephone | 201-569-2112
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Fax | 201-569-7605
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. CHRIS KOJANIJ
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Credential | DDS
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Telephone | 201-569-2112
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | D14859
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License Number State | NJ
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