Provider Demographics
NPI:1205217247
Name:FRIENDLY DENTAL OF SOMERSET PC
Entity Type:Organization
Organization Name:FRIENDLY DENTAL OF SOMERSET PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KATERINA
Authorized Official - Middle Name:
Authorized Official - Last Name:TOPOL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:732-649-3860
Mailing Address - Street 1:31 CLYDE RD STE 101
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SOMERSET
Mailing Address - State:NJ
Mailing Address - Zip Code:08873-5047
Mailing Address - Country:US
Mailing Address - Phone:732-649-3860
Mailing Address - Fax:848-216-3364
Practice Address - Street 1:31 CLYDE RD STE 101
Practice Address - Street 2:SUITE 101
Practice Address - City:SOMERSET
Practice Address - State:NJ
Practice Address - Zip Code:08873-5047
Practice Address - Country:US
Practice Address - Phone:732-649-3860
Practice Address - Fax:848-216-3364
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-16
Last Update Date:2017-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ21086122300000X
NJ18818122300000X
NJ20486122300000X
NJ25006122300000X
NJ789003122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0175439Medicaid