Provider Demographics
NPI:1083897375
Name:B & K FAMILY DENTAL, LLC
Entity Type:Organization
Organization Name:B & K FAMILY DENTAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SVETLANA
Authorized Official - Middle Name:B
Authorized Official - Last Name:KONSTANTINOVA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:908-354-1500
Mailing Address - Street 1:707 ELIZABETH AVE
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH
Mailing Address - State:NJ
Mailing Address - Zip Code:07201-2806
Mailing Address - Country:US
Mailing Address - Phone:908-354-1500
Mailing Address - Fax:908-354-1502
Practice Address - Street 1:707 ELIZABETH AVE
Practice Address - Street 2:
Practice Address - City:ELIZABETH
Practice Address - State:NJ
Practice Address - Zip Code:07201-2806
Practice Address - Country:US
Practice Address - Phone:908-354-1500
Practice Address - Fax:908-354-1502
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-10
Last Update Date:2007-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI02322000261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental