Provider Demographics
NPI:1265505739
Name:FRANKLIN DENTAL CENTER PA
Entity Type:Organization
Organization Name:FRANKLIN DENTAL CENTER PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DURDANA
Authorized Official - Middle Name:GEM
Authorized Official - Last Name:GILL
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:201-891-5080
Mailing Address - Street 1:574 FRANKLIN AVE
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN LAKES
Mailing Address - State:NJ
Mailing Address - Zip Code:07417
Mailing Address - Country:US
Mailing Address - Phone:201-891-5080
Mailing Address - Fax:201-891-5581
Practice Address - Street 1:574 FRANKLIN AVE
Practice Address - Street 2:
Practice Address - City:FRANKLIN LAKES
Practice Address - State:NJ
Practice Address - Zip Code:07417
Practice Address - Country:US
Practice Address - Phone:201-891-5080
Practice Address - Fax:201-891-5581
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI017981122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty