Provider Demographics
NPI:1093218067
Name:PLATINUM DENTAL GROUP BAYONNE, LLC
Entity Type:Organization
Organization Name:PLATINUM DENTAL GROUP BAYONNE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SAPAN
Authorized Official - Middle Name:
Authorized Official - Last Name:PARIKH
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:201-858-8584
Mailing Address - Street 1:919 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:BAYONNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07002-3051
Mailing Address - Country:US
Mailing Address - Phone:201-858-8584
Mailing Address - Fax:
Practice Address - Street 1:919 BROADWAY
Practice Address - Street 2:
Practice Address - City:BAYONNE
Practice Address - State:NJ
Practice Address - Zip Code:07002-3051
Practice Address - Country:US
Practice Address - Phone:201-858-8584
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-15
Last Update Date:2020-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty