Provider Demographics
NPI:1366657017
Name:WASHINGTON DENTAL ASSOCIATES
Entity Type:Organization
Organization Name:WASHINGTON DENTAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DARREN
Authorized Official - Middle Name:W
Authorized Official - Last Name:TONG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:201-384-2425
Mailing Address - Street 1:19 LEGION DR
Mailing Address - Street 2:
Mailing Address - City:BERGENFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07621-2314
Mailing Address - Country:US
Mailing Address - Phone:201-384-2425
Mailing Address - Fax:201-384-5642
Practice Address - Street 1:19 LEGION DR
Practice Address - Street 2:
Practice Address - City:BERGENFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07621-2314
Practice Address - Country:US
Practice Address - Phone:201-384-2425
Practice Address - Fax:201-384-5642
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI018291001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty