Provider Demographics
NPI:1235844929
Name:DENTAL SPECIALISTS OF NJ LLC
Entity Type:Organization
Organization Name:DENTAL SPECIALISTS OF NJ LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGIONAL OPERATIONS
Authorized Official - Prefix:MS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:BUNTZEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-694-5290
Mailing Address - Street 1:180 OLD TAPPAN ROAD
Mailing Address - Street 2:BUILDING 1 SECOND FLOOR
Mailing Address - City:OLD TAPPAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07675
Mailing Address - Country:US
Mailing Address - Phone:201-694-5290
Mailing Address - Fax:
Practice Address - Street 1:950 AVENUE C
Practice Address - Street 2:
Practice Address - City:BAYONNE
Practice Address - State:NJ
Practice Address - Zip Code:07002
Practice Address - Country:US
Practice Address - Phone:201-339-8019
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DENTAL SPECIALISTS OF NJ LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-01-18
Last Update Date:2023-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223D0004XDental ProvidersDentistDentist AnesthesiologistGroup - Multi-Specialty