Provider Demographics
NPI:1073920666
Name:FIRST CHOICE DENTAL GROUP, LLC
Entity Type:Organization
Organization Name:FIRST CHOICE DENTAL GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHAIRMAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:FEDERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:201-592-7920
Mailing Address - Street 1:2185 LEMOINE AVE
Mailing Address - Street 2:STE 1K
Mailing Address - City:FORT LEE
Mailing Address - State:NJ
Mailing Address - Zip Code:07024-6036
Mailing Address - Country:US
Mailing Address - Phone:201-592-7920
Mailing Address - Fax:201-592-0971
Practice Address - Street 1:2185 LEMOINE AVE
Practice Address - Street 2:STE 1K
Practice Address - City:FORT LEE
Practice Address - State:NJ
Practice Address - Zip Code:07024-6036
Practice Address - Country:US
Practice Address - Phone:201-592-7920
Practice Address - Fax:201-592-0971
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-16
Last Update Date:2014-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI011441001223G0001X
NJ22DI025129001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty