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NPI Code Detail

MEDICARE: DENTIQUE,INC

MEDICARE: DENTIQUE,INC
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
1122300000XDentist22DI02159500NJ
2122300000XDentist22DI02269300NJ
3122300000XDentist22DI02252400NJ

General Provider Information

NPI Number : 1952424137
Entity Type Code : Organization
Provider Name (Legal Business Name) : DENTIQUE,INC
Provider Business Mailing Address
First Line : 30 AVE AT PORT IMPERIAL
Second Line : #210
City : WEST NEW YORK
State : NJ
Zip : 07093-8372
Country : US
Telephone Number : 201-704-7526
Fax Number : 201-766-8625
Provider Business Practice Location Address
First Line : 70 HUDSON ST
Second Line : PENTHOUSE SUITE
City : HOBOKEN
State : NJ
Zip : 07030-5630
Country : US
Telephone Number : 201-704-7526
Fax Number : 201-766-8625
Authorized Official
Title or Position : DENTIST
Name : DR. ANNU LUTHRA
Credential : DDS
Telephone Number : 201-704-7526
Provider Enumeration Date : 04/10/2007
Last Update Date : 08/22/2020

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Directions to “DENTIQUE,INC ” Practice Location

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