Provider Demographics
NPI:1295816783
Name:COSMETIC & FAMILY DENTISTRY PA
Entity Type:Organization
Organization Name:COSMETIC & FAMILY DENTISTRY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BEN
Authorized Official - Middle Name:M
Authorized Official - Last Name:KERSHENBAUM
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:201-797-2190
Mailing Address - Street 1:26-07 BROADWAY
Mailing Address - Street 2:SUITE 22
Mailing Address - City:FAIR LAWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07410-3832
Mailing Address - Country:US
Mailing Address - Phone:201-797-2190
Mailing Address - Fax:201-797-1929
Practice Address - Street 1:26-07 BROADWAY
Practice Address - Street 2:SUITE 22
Practice Address - City:FAIR LAWN
Practice Address - State:NJ
Practice Address - Zip Code:07410-3832
Practice Address - Country:US
Practice Address - Phone:201-797-2190
Practice Address - Fax:201-797-1929
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ165151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty