Provider Demographics
NPI:1114946894
Name:DENTAL HEALTH PROVIDERS OF NEW JERSEY PC
Entity Type:Organization
Organization Name:DENTAL HEALTH PROVIDERS OF NEW JERSEY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIA MILAGROS
Authorized Official - Middle Name:
Authorized Official - Last Name:YAMBAO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:973-218-9190
Mailing Address - Street 1:28 MILLBURN AVE
Mailing Address - Street 2:STE #2
Mailing Address - City:SPRINGFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07081-1023
Mailing Address - Country:US
Mailing Address - Phone:973-218-9190
Mailing Address - Fax:973-218-9192
Practice Address - Street 1:28 MILLBURN AVE
Practice Address - Street 2:STE #2
Practice Address - City:SPRINGFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07081-1023
Practice Address - Country:US
Practice Address - Phone:973-218-9190
Practice Address - Fax:973-218-9192
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22D1022494001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty