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General NPI Number Information
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NPI Number | 1780009019
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Entity Type | Organization
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Legal Business Name | LAFAYETTE FAMILY DENTAL CARE,LLC
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Dates
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Enumeration Date | 02/24/2014
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Last Update Date | 02/24/2014
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Provider Practice Location Address
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Address Line | 540 LAFAYETTE AVE
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City | HAWTHORNE
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State | NJ
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Zip | 07506-2448
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Country | US
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Telephone | 551-358-7421
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Fax |
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Provider Business Mailing Address
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Address Line | 540 LAFAYETTE AVE
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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 | 551-358-7421
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KAUSHIK PATEL
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Credential |
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Telephone | 551-358-7421
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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