Provider Demographics
NPI:1215192810
Name:NOVA DENTAL CENTER
Entity Type:Organization
Organization Name:NOVA DENTAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LIDIA
Authorized Official - Middle Name:S
Authorized Official - Last Name:SIMEONOVA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:201-936-7300
Mailing Address - Street 1:600 CLINTON ST
Mailing Address - Street 2:
Mailing Address - City:HOBOKEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07030-2817
Mailing Address - Country:US
Mailing Address - Phone:201-936-7300
Mailing Address - Fax:
Practice Address - Street 1:600 CLINTON ST
Practice Address - Street 2:
Practice Address - City:HOBOKEN
Practice Address - State:NJ
Practice Address - Zip Code:07030-2817
Practice Address - Country:US
Practice Address - Phone:201-936-7300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-23
Last Update Date:2008-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI02291800122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty