MEDICARE: CRANFORD CENTER FOR PERIODONTICS & DENTAL IMPLANTS

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	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1841444262
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CRANFORD CENTER FOR PERIODONTICS & DENTAL IMPLANTS

Provider Business Mailing Address
First Line	:	191 NORTH AVE E
Second Line	:
City	:	CRANFORD
State	:	NJ
Zip	:	07016-2438
Country	:	US
Telephone Number	:	908-709-6777
Fax Number	:

Provider Business Practice Location Address
First Line	:	191 NORTH AVE E
Second Line	:
City	:	CRANFORD
State	:	NJ
Zip	:	07016-2438
Country	:	US
Telephone Number	:	908-709-6777
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MEHDI SABER
Credential	:	D.D.S. M.S.D
Telephone Number	:	908-709-6777

Provider Enumeration Date	:	11/12/2008
Last Update Date	:	11/12/2008

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