Provider Demographics
NPI:1073662300
Name:TMJ & ORTHO CENTER, LLC
Entity Type:Organization
Organization Name:TMJ & ORTHO CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:E
Authorized Official - Last Name:CABANA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:973-263-6200
Mailing Address - Street 1:362 HAWKINS PL
Mailing Address - Street 2:
Mailing Address - City:BOONTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07005-1128
Mailing Address - Country:US
Mailing Address - Phone:973-263-6200
Mailing Address - Fax:973-263-6210
Practice Address - Street 1:362 HAWKINS PL
Practice Address - Street 2:
Practice Address - City:BOONTON
Practice Address - State:NJ
Practice Address - Zip Code:07005-1128
Practice Address - Country:US
Practice Address - Phone:973-263-6200
Practice Address - Fax:973-263-6210
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-09
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty