MEDICARE: INFINITY DENTAL WELLNESS LLC

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	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1760244479
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INFINITY DENTAL WELLNESS LLC

Provider Business Mailing Address
First Line	:	86 MORGAN ST
Second Line	:
City	:	BERGENFIELD
State	:	NJ
Zip	:	07621-3515
Country	:	US
Telephone Number	:	516-509-0360
Fax Number	:

Provider Business Practice Location Address
First Line	:	327 BRIDGE PLZ N
Second Line	:
City	:	FORT LEE
State	:	NJ
Zip	:	07024-5051
Country	:	US
Telephone Number	:	201-429-0097
Fax Number	:

Authorized Official
Title or Position	:	DDS
Name	:	JONATHAN ODINSKY
Credential	:
Telephone Number	:	516-509-0360

Provider Enumeration Date	:	01/29/2024
Last Update Date	:	01/29/2024

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