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General NPI Number Information
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NPI Number | 1922572478
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Entity Type | Organization
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Legal Business Name | EDGEWATER DENTAL PARTNERS, PC
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Dates
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Enumeration Date | 01/17/2019
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Last Update Date | 02/10/2020
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Provider Practice Location Address
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Address Line | 725 RIVER RD STE 104
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City | EDGEWATER
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State | NJ
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Zip | 07020-1170
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Country | US
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Telephone | 917-513-6419
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1118
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City | FORT LEE
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State | NJ
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Zip | 07024-1118
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MANAGING PARTNER
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Name | DR. LEWIS CHEN
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Credential | DDS
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Telephone | 917-513-6419
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number |
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License Number State |
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Taxonomy #3
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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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