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General NPI Number Information
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NPI Number | 1861835183
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Entity Type | Organization
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Legal Business Name | KEANSBURG FAMILY DENTAL, LLC
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Dates
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Enumeration Date | 04/17/2013
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Last Update Date | 04/17/2013
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Provider Practice Location Address
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Address Line | 365 CARR AVE
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City | KEANSBURG
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State | NJ
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Zip | 07734-1419
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Country | US
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Telephone | 743-945-8283
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Fax |
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Provider Business Mailing Address
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Address Line | 365 CARR AVE
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City | KEANSBURG
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State | NJ
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Zip | 07734-1419
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Country | US
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Telephone | 743-945-8283
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Fax |
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Authorized Official
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Title or Position | OPERATING MANAGER
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Name | DR. NINA KARAMZADEH
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Credential | D.D.S.
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Telephone | 732-945-8283
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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 | 22D102285901
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License Number State | NJ
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