Provider Demographics
NPI:1164874376
Name:RUTGERS UNIVERSITY DENTAL ASSOCIATES-NEW BRUNSWICK
Entity Type:Organization
Organization Name:RUTGERS UNIVERSITY DENTAL ASSOCIATES-NEW BRUNSWICK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LENETTE
Authorized Official - Middle Name:M
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-972-8668
Mailing Address - Street 1:135 SOMERSET ST
Mailing Address - Street 2:
Mailing Address - City:NEW BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08901-2072
Mailing Address - Country:US
Mailing Address - Phone:973-972-8668
Mailing Address - Fax:
Practice Address - Street 1:135 SOMERSET ST
Practice Address - Street 2:
Practice Address - City:NEW BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08901-2072
Practice Address - Country:US
Practice Address - Phone:973-972-8668
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-12
Last Update Date:2016-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI02319600122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty