MEDICARE: ENDODONTIC ASSOCIATES OF CLIFTON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223E0200X	Endodontics

General Provider Information

NPI Number	:	1417040445
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ENDODONTIC ASSOCIATES OF CLIFTON

Provider Business Mailing Address
First Line	:	1001 CLIFTON AVE
Second Line	:	SUITE 1A
City	:	CLIFTON
State	:	NJ
Zip	:	07013-3586
Country	:	US
Telephone Number	:	973-773-6050
Fax Number	:	973-773-3520

Provider Business Practice Location Address
First Line	:	1001 CLIFTON AVE
Second Line	:	SUITE 1A
City	:	CLIFTON
State	:	NJ
Zip	:	07013-3586
Country	:	US
Telephone Number	:	973-773-6050
Fax Number	:	973-773-3520

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. RONALD IVAN DEBLINGER
Credential	:	D.M.D.
Telephone Number	:	973-773-6050

Provider Enumeration Date	:	10/02/2006
Last Update Date	:	08/22/2020

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