=====================================================
General NPI Number Information
=====================================================
NPI Number | 1871638783
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | INMAN DENTAL CARE PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/20/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3 PROGRESS STREET SUITE NO 101
-----------------------------------------------------
City | EDISON
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08820
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 908-754-5252
-----------------------------------------------------
Fax | 908-754-6663
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3 PROGRESS STREET SUITE NO 101
-----------------------------------------------------
City | EDISON
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08820
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 908-754-5252
-----------------------------------------------------
Fax | 908-754-6663
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DENTIST
-----------------------------------------------------
Name | SERAJUS SALEKIN QUADERI
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 908-754-5252
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 17788
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------