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General NPI Number Information
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NPI Number | 1841406782
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Entity Type | Organization
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Legal Business Name | LYNDHURST DENTAL MEDICINE, LLC
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Dates
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Enumeration Date | 05/15/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 464 VALLEY BROOK AVE
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City | LYNDHURST
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State | NJ
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Zip | 07071-1998
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Country | US
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Telephone | 201-933-9092
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Fax | 201-933-6690
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Provider Business Mailing Address
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Address Line | 464 VALLEY BROOK AVE
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City | LYNDHURST
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State | NJ
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Zip | 07071-1998
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Country | US
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Telephone | 201-933-9092
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Fax | 201-933-6690
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Authorized Official
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Title or Position | OWNER
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Name | DR. ROSS LESSER
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Credential | DMD
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Telephone | 201-933-9092
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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 | DI17675
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License Number State | NJ
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