Provider Demographics
NPI:1053688721
Name:PALISADES DENTAL CARE
Entity Type:Organization
Organization Name:PALISADES DENTAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:YAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:KRYZMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:201-568-9811
Mailing Address - Street 1:135 COUNTY RD
Mailing Address - Street 2:
Mailing Address - City:CRESSKILL
Mailing Address - State:NJ
Mailing Address - Zip Code:07626-2203
Mailing Address - Country:US
Mailing Address - Phone:201-568-9811
Mailing Address - Fax:201-568-5494
Practice Address - Street 1:135 COUNTY RD
Practice Address - Street 2:
Practice Address - City:CRESSKILL
Practice Address - State:NJ
Practice Address - Zip Code:07626-2203
Practice Address - Country:US
Practice Address - Phone:201-568-9811
Practice Address - Fax:201-568-5494
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-24
Last Update Date:2011-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI02398000122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty