Provider Demographics
NPI:1346606969
Name:21ST CENTURY DENTAL CARE PC
Entity Type:Organization
Organization Name:21ST CENTURY DENTAL CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:VITALU
Authorized Official - Middle Name:
Authorized Official - Last Name:FRIEDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:908-604-5959
Mailing Address - Street 1:413 KING GEORGE RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:BASKING RIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07920-2816
Mailing Address - Country:US
Mailing Address - Phone:908-604-5959
Mailing Address - Fax:
Practice Address - Street 1:413 KING GEORGE RD
Practice Address - Street 2:SUITE 201
Practice Address - City:BASKING RIDGE
Practice Address - State:NJ
Practice Address - Zip Code:07920-2816
Practice Address - Country:US
Practice Address - Phone:908-604-5959
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-12
Last Update Date:2016-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI02177200261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental