Provider Demographics
NPI:1154086254
Name:DENTAL WELLNESS OF CLIFTON
Entity Type:Organization
Organization Name:DENTAL WELLNESS OF CLIFTON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RADA
Authorized Official - Middle Name:
Authorized Official - Last Name:MEYTIN
Authorized Official - Suffix:
Authorized Official - Credentials:DMS
Authorized Official - Phone:973-473-2410
Mailing Address - Street 1:1149 BLOOMFIELD AVE STE A
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07012-2314
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1149 BLOOMFIELD AVE STE A
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07012-2314
Practice Address - Country:US
Practice Address - Phone:973-473-2410
Practice Address - Fax:973-473-4552
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-03
Last Update Date:2021-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty