Provider Demographics
NPI:1295814051
Name:DENTAL HEALTH ASSOCIATES PA
Entity Type:Organization
Organization Name:DENTAL HEALTH ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CLIFFORD
Authorized Official - Middle Name:G
Authorized Official - Last Name:LISMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:908-387-6120
Mailing Address - Street 1:320 SOUTH MAIN STREET
Mailing Address - Street 2:CORPORATE OFFICE 2ND FLR
Mailing Address - City:PHILLIPSBURG
Mailing Address - State:NJ
Mailing Address - Zip Code:08865
Mailing Address - Country:US
Mailing Address - Phone:908-387-6120
Mailing Address - Fax:908-387-8322
Practice Address - Street 1:957 RT 33 & PAXSON AVE
Practice Address - Street 2:HAMILTON SQUARE MALL
Practice Address - City:HAMILTON
Practice Address - State:NJ
Practice Address - Zip Code:08690
Practice Address - Country:US
Practice Address - Phone:609-587-5858
Practice Address - Fax:609-587-4606
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty