Provider Demographics
NPI:1285035618
Name:VIRTUOSO DENTAL CARE LLC
Entity Type:Organization
Organization Name:VIRTUOSO DENTAL CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:NEETHA
Authorized Official - Middle Name:
Authorized Official - Last Name:RAVINDRA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:973-472-1010
Mailing Address - Street 1:183 JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:PASSAIC
Mailing Address - State:NJ
Mailing Address - Zip Code:07055-5106
Mailing Address - Country:US
Mailing Address - Phone:973-472-1010
Mailing Address - Fax:973-473-6232
Practice Address - Street 1:183 JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:PASSAIC
Practice Address - State:NJ
Practice Address - Zip Code:07055-5106
Practice Address - Country:US
Practice Address - Phone:973-472-1010
Practice Address - Fax:973-473-6232
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-04
Last Update Date:2014-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI1995600122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty