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General NPI Number Information
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NPI Number | 1992929889
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Entity Type | Organization
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Legal Business Name | FORDS FAMILY DENTAL CARE LLC
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Dates
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Enumeration Date | 04/12/2007
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Last Update Date | 09/01/2009
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Provider Practice Location Address
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Address Line | 532 NEW BRUNSWICK AVE
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City | FORDS
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State | NJ
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Zip | 08863
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Country | US
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Telephone | 732-738-9087
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Fax | 732-738-7317
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Provider Business Mailing Address
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Address Line | 532 NEW BRUNSWICK AVENUE
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City | FORDS
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State | NJ
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Zip | 08863
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Country | US
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Telephone | 732-738-9087
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Fax | 732-738-7317
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Authorized Official
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Title or Position | DOCTOR/OWNER
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Name | STELLA EFTHYMIOU-BACKOS
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Credential | DDS
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Telephone | 732-738-9087
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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 | DI15467
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DI16918
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License Number State | NJ
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