Provider Demographics
NPI:1053631994
Name:DENTAL HEALTH ASSOCIATES, P.A.
Entity Type:Organization
Organization Name:DENTAL HEALTH ASSOCIATES, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CLIFFORD
Authorized Official - Middle Name:G
Authorized Official - Last Name:LISMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:908-387-6120
Mailing Address - Street 1:320 SOUTH MAIN STREET
Mailing Address - Street 2:CORPORATE OFFICE - 2ND FLR
Mailing Address - City:PHILLIPSBURG
Mailing Address - State:NJ
Mailing Address - Zip Code:08865
Mailing Address - Country:US
Mailing Address - Phone:908-387-6120
Mailing Address - Fax:908-387-8322
Practice Address - Street 1:5170 RT. 9 S
Practice Address - Street 2:
Practice Address - City:HOWELL
Practice Address - State:NJ
Practice Address - Zip Code:07731
Practice Address - Country:US
Practice Address - Phone:732-367-8600
Practice Address - Fax:732-367-8606
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DENTAL HEALTH ASSOCIATES, P.A.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-06-02
Last Update Date:2010-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty