Provider Demographics
NPI:1093152746
Name:VERONA-CEDAR GROVE DENTAL ASSOCIATES
Entity Type:Organization
Organization Name:VERONA-CEDAR GROVE DENTAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:J
Authorized Official - Last Name:MADSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:973-239-6969
Mailing Address - Street 1:756 POMPTON AVE
Mailing Address - Street 2:
Mailing Address - City:CEDAR GROVE
Mailing Address - State:NJ
Mailing Address - Zip Code:07009-1229
Mailing Address - Country:US
Mailing Address - Phone:973-239-6969
Mailing Address - Fax:973-239-6295
Practice Address - Street 1:756 POMPTON AVE
Practice Address - Street 2:
Practice Address - City:CEDAR GROVE
Practice Address - State:NJ
Practice Address - Zip Code:07009-1229
Practice Address - Country:US
Practice Address - Phone:973-239-6969
Practice Address - Fax:973-239-6295
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-03
Last Update Date:2013-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI016988001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty