Provider Demographics
NPI:1093874760
Name:DNA DENTAL
Entity Type:Organization
Organization Name:DNA DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KEYANNA
Authorized Official - Middle Name:T
Authorized Official - Last Name:INGRAU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-535-4300
Mailing Address - Street 1:349 E. NORTHFIELD RD
Mailing Address - Street 2:SUITE #207
Mailing Address - City:LIVINGSTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07039
Mailing Address - Country:US
Mailing Address - Phone:973-535-4300
Mailing Address - Fax:973-535-4308
Practice Address - Street 1:349 EAST NORTHFIELD RD
Practice Address - Street 2:SUITE #207
Practice Address - City:LIVINGSTON
Practice Address - State:NJ
Practice Address - Zip Code:07039
Practice Address - Country:US
Practice Address - Phone:973-535-4300
Practice Address - Fax:973-535-4308
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-08
Last Update Date:2010-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1223G0001X, 1223P0300X
NJ22D101996200126800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes126800000XDental ProvidersDental AssistantGroup - Multi-Specialty
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty