Provider Demographics
NPI:1033414560
Name:PRINCETON RESTORATIVE & IMPLANT DENTISTRY LLC
Entity Type:Organization
Organization Name:PRINCETON RESTORATIVE & IMPLANT DENTISTRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:I
Authorized Official - Last Name:HUDIS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:609-924-7910
Mailing Address - Street 1:187 N HARRISON ST
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08540-3517
Mailing Address - Country:US
Mailing Address - Phone:609-924-7910
Mailing Address - Fax:
Practice Address - Street 1:187 N HARRISON ST
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:NJ
Practice Address - Zip Code:08540-3517
Practice Address - Country:US
Practice Address - Phone:609-924-7910
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-13
Last Update Date:2011-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0700XDental ProvidersDentistProsthodonticsGroup - Single Specialty