Provider Demographics
NPI:1326022120
Name:CESPEDES DENTAL SERVICES
Entity Type:Organization
Organization Name:CESPEDES DENTAL SERVICES
Other - Org Name:PASSAIC PARK DENTAL
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:NELFA
Authorized Official - Middle Name:
Authorized Official - Last Name:CESPEDES
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:973-471-0099
Mailing Address - Street 1:293 MAIN AVE
Mailing Address - Street 2:
Mailing Address - City:PASSAIC
Mailing Address - State:NJ
Mailing Address - Zip Code:07055-5629
Mailing Address - Country:US
Mailing Address - Phone:973-471-0099
Mailing Address - Fax:973-614-1751
Practice Address - Street 1:293 MAIN AVE
Practice Address - Street 2:
Practice Address - City:PASSAIC
Practice Address - State:NJ
Practice Address - Zip Code:07055-5629
Practice Address - Country:US
Practice Address - Phone:973-471-0099
Practice Address - Fax:973-614-1751
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-05
Last Update Date:2008-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty