Provider Demographics
NPI:1083910285
Name:ADVANCED DENTISTRY OF SUMMIT, LLC
Entity Type:Organization
Organization Name:ADVANCED DENTISTRY OF SUMMIT, LLC
Other - Org Name:ADVANCED DENTISTRY, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CORINA
Authorized Official - Middle Name:
Authorized Official - Last Name:ATANASE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:973-635-0626
Mailing Address - Street 1:33 MAIN ST
Mailing Address - Street 2:STE. 101
Mailing Address - City:CHATHAM
Mailing Address - State:NJ
Mailing Address - Zip Code:07928-2433
Mailing Address - Country:US
Mailing Address - Phone:973-635-0626
Mailing Address - Fax:
Practice Address - Street 1:33 MAIN ST
Practice Address - Street 2:STE. 101
Practice Address - City:CHATHAM
Practice Address - State:NJ
Practice Address - Zip Code:07928-2433
Practice Address - Country:US
Practice Address - Phone:973-635-0626
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-04
Last Update Date:2011-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI02372900332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1346393717OtherDR. ATANASE NPI
NJ6485920001Medicare NSC