Provider Demographics
NPI:1083712343
Name:GEORGETOWN DENTAL ASSOCIATES, L.L.C.
Entity Type:Organization
Organization Name:GEORGETOWN DENTAL ASSOCIATES, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:D.D.S.
Authorized Official - Prefix:DR
Authorized Official - First Name:LOLA
Authorized Official - Middle Name:A
Authorized Official - Last Name:PALADINO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:732-536-2600
Mailing Address - Street 1:821 TENNENT RD
Mailing Address - Street 2:
Mailing Address - City:MANALAPAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07726-8250
Mailing Address - Country:US
Mailing Address - Phone:732-536-2600
Mailing Address - Fax:732-536-7574
Practice Address - Street 1:821 TENNENT RD
Practice Address - Street 2:
Practice Address - City:MANALAPAN
Practice Address - State:NJ
Practice Address - Zip Code:07726-8250
Practice Address - Country:US
Practice Address - Phone:732-536-2600
Practice Address - Fax:732-536-7574
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI152551223G0001X
NJDI163641223G0001X
NJDI0213381223G0001X
NJDI163731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty