Provider Demographics
NPI: | 1295000180 |
---|---|
Name: | DR. SAIMA MIAN LLC |
Entity Type: | Organization |
Organization Name: | DR. SAIMA MIAN LLC |
Other - Org Name: | GENTLE FAMILY DENTISTRY |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | PRESIDENT |
Authorized Official - Prefix: | DR |
Authorized Official - First Name: | SAIMA |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | MIAN |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | DMD |
Authorized Official - Phone: | 201-866-3299 |
Mailing Address - Street 1: | 402 36TH ST |
Mailing Address - Street 2: | |
Mailing Address - City: | UNION CITY |
Mailing Address - State: | NJ |
Mailing Address - Zip Code: | 07087-4712 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 201-866-3299 |
Mailing Address - Fax: | 201-866-3396 |
Practice Address - Street 1: | 402 36TH ST |
Practice Address - Street 2: | |
Practice Address - City: | UNION CITY |
Practice Address - State: | NJ |
Practice Address - Zip Code: | 07087-4712 |
Practice Address - Country: | US |
Practice Address - Phone: | 201-866-3299 |
Practice Address - Fax: | 201-866-3396 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2012-03-12 |
Last Update Date: | 2012-03-12 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
NJ | 21485 | 122300000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 122300000X | Dental Providers | Dentist | Group - Single Specialty |