Provider Demographics
NPI:1366645913
Name:CENTRAL JERSEY PERIODONTICS & IMPLANT
Entity Type:Organization
Organization Name:CENTRAL JERSEY PERIODONTICS & IMPLANT
Other - Org Name:LUCIAN L KAHAN DDS PA
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PERIODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LUCIAN
Authorized Official - Middle Name:L
Authorized Official - Last Name:KAHAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:732-257-6500
Mailing Address - Street 1:177 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:EAST BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08816
Mailing Address - Country:US
Mailing Address - Phone:732-257-6500
Mailing Address - Fax:732-257-6531
Practice Address - Street 1:177 MAIN ST
Practice Address - Street 2:
Practice Address - City:EAST BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08816
Practice Address - Country:US
Practice Address - Phone:732-257-6500
Practice Address - Fax:732-257-6531
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-08
Last Update Date:2008-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ112091223P0300X
NJ220I021662001223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty