Provider Demographics
NPI:1083971584
Name:BERGEN SMILE CONFIDENCE,P.A.
Entity Type:Organization
Organization Name:BERGEN SMILE CONFIDENCE,P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:C
Authorized Official - Last Name:KORINIS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:201-444-2383
Mailing Address - Street 1:541 CEDAR HILL AVE
Mailing Address - Street 2:
Mailing Address - City:WYCKOFF
Mailing Address - State:NJ
Mailing Address - Zip Code:07481-2150
Mailing Address - Country:US
Mailing Address - Phone:201-444-2383
Mailing Address - Fax:201-444-6454
Practice Address - Street 1:541 CEDAR HILL AVE
Practice Address - Street 2:
Practice Address - City:WYCKOFF
Practice Address - State:NJ
Practice Address - Zip Code:07481-2150
Practice Address - Country:US
Practice Address - Phone:201-444-2383
Practice Address - Fax:201-444-6454
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-20
Last Update Date:2012-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI01186000122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty