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General NPI Number Information
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NPI Number | 1932311941
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Entity Type | Organization
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Legal Business Name | PEDIATRIC DENTAL ASSOCIATES LLC
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Dates
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Enumeration Date | 05/03/2007
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 195 SOUTH MAPLE AVE.
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City | RIDGEWOOD
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State | NJ
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Zip | 07450
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Country | US
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Telephone | 201-652-7020
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Fax | 201-652-1550
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Provider Business Mailing Address
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Address Line | 195 SOUTH MAPLE AVE.
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City | RIDGEWOOD
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State | NJ
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Zip | 07450
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Country | US
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Telephone | 201-652-7020
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Fax | 201-652-1550
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Authorized Official
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Title or Position | SECRETARY
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Name | DR. SARI C ZIMMER
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Credential | DMD
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Telephone | 201-652-7020
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 19114
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 22065
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License Number State | NJ
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Taxonomy #3
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 18921
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License Number State | NJ
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Taxonomy #4
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 10720
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License Number State | NJ
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Taxonomy #5
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 9871
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License Number State | NJ
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