=====================================================
General NPI Number Information
=====================================================
NPI Number | 1760187520
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THRIVE DENTAL WELLNESS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/03/2023
-----------------------------------------------------
Last Update Date | 04/03/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4301 US HIGHWAY 1 STE 100A
-----------------------------------------------------
City | MONMOUTH JUNCTION
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08852-1973
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 201-952-2490
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8B TRIUMPH CT
-----------------------------------------------------
City | EAST RUTHERFORD
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07073-1145
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 201-952-2490
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MEMBER/OWNER
-----------------------------------------------------
Name | DR. MISHEAL ARTANI
-----------------------------------------------------
Credential | DMD
-----------------------------------------------------
Telephone | 201-952-2490
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QD0000X
-----------------------------------------------------
Taxonomy Name | Dental Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------