Provider Demographics
NPI:1235421496
Name:LASTING IMPRESSIONS DENTISTRY LLC
Entity Type:Organization
Organization Name:LASTING IMPRESSIONS DENTISTRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:SAVAGE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:201-836-4335
Mailing Address - Street 1:185 CEDAR LN
Mailing Address - Street 2:SUITE U-1
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07666-4316
Mailing Address - Country:US
Mailing Address - Phone:201-836-4335
Mailing Address - Fax:201-836-5920
Practice Address - Street 1:185 CEDAR LN
Practice Address - Street 2:SUITE U-1
Practice Address - City:TEANECK
Practice Address - State:NJ
Practice Address - Zip Code:07666-4316
Practice Address - Country:US
Practice Address - Phone:201-836-4335
Practice Address - Fax:201-836-5920
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-06
Last Update Date:2011-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22D101805200261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1073661427OtherGENERAL DENTIST