Provider Demographics
NPI:1164195533
Name:NEW PROVIDENCE DENTISTRY LLC
Entity Type:Organization
Organization Name:NEW PROVIDENCE DENTISTRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:HERKO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:908-376-9297
Mailing Address - Street 1:571 CENTRAL AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:NEW PROVIDENCE
Mailing Address - State:NJ
Mailing Address - Zip Code:07974-1547
Mailing Address - Country:US
Mailing Address - Phone:908-376-9297
Mailing Address - Fax:
Practice Address - Street 1:571 CENTRAL AVE STE 100
Practice Address - Street 2:
Practice Address - City:NEW PROVIDENCE
Practice Address - State:NJ
Practice Address - Zip Code:07974-1547
Practice Address - Country:US
Practice Address - Phone:908-376-9297
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-30
Last Update Date:2021-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty