Provider Demographics
NPI:1114338936
Name:DENTAL CHARM LLC
Entity Type:Organization
Organization Name:DENTAL CHARM LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:SHICK
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:973-921-9097
Mailing Address - Street 1:116 MILLBURN AVE
Mailing Address - Street 2:SUITE 109
Mailing Address - City:MILLBURN
Mailing Address - State:NJ
Mailing Address - Zip Code:07041-1943
Mailing Address - Country:US
Mailing Address - Phone:973-921-9097
Mailing Address - Fax:973-921-9196
Practice Address - Street 1:116 MILLBURN AVE
Practice Address - Street 2:SUITE 109
Practice Address - City:MILLBURN
Practice Address - State:NJ
Practice Address - Zip Code:07041-1943
Practice Address - Country:US
Practice Address - Phone:973-921-9097
Practice Address - Fax:973-921-9196
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-14
Last Update Date:2014-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI02414200261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental