Provider Demographics
NPI:1124562715
Name:ELIZABETH NOBOA DENTISTA FAMILIAR PC
Entity Type:Organization
Organization Name:ELIZABETH NOBOA DENTISTA FAMILIAR PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:NOBOA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-246-0080
Mailing Address - Street 1:134 GRAND PL
Mailing Address - Street 2:
Mailing Address - City:KEARNY
Mailing Address - State:NJ
Mailing Address - Zip Code:07032-1847
Mailing Address - Country:US
Mailing Address - Phone:201-246-0080
Mailing Address - Fax:
Practice Address - Street 1:134 GRAND PL
Practice Address - Street 2:
Practice Address - City:KEARNY
Practice Address - State:NJ
Practice Address - Zip Code:07032-1847
Practice Address - Country:US
Practice Address - Phone:201-246-0080
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-15
Last Update Date:2016-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty