Provider Demographics
NPI:1063628550
Name:WAYNE DENTAL ARTS, LLC
Entity Type:Organization
Organization Name:WAYNE DENTAL ARTS, LLC
Other - Org Name:WAYNE DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROSS
Authorized Official - Middle Name:
Authorized Official - Last Name:LESSER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:973-956-7772
Mailing Address - Street 1:601 HAMBURG TPKE
Mailing Address - Street 2:SUITE 206
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-2048
Mailing Address - Country:US
Mailing Address - Phone:973-956-7772
Mailing Address - Fax:973-956-8788
Practice Address - Street 1:601 HAMBURG TPKE
Practice Address - Street 2:SUITE 206
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-2048
Practice Address - Country:US
Practice Address - Phone:973-956-7772
Practice Address - Fax:973-956-8788
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-14
Last Update Date:2008-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI176751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty