Provider Demographics
NPI:1376797068
Name:MONTGOMERY GREENE DENTAL
Entity Type:Organization
Organization Name:MONTGOMERY GREENE DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LANA
Authorized Official - Middle Name:
Authorized Official - Last Name:BUNIS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:201-204-0737
Mailing Address - Street 1:105 GREENE ST
Mailing Address - Street 2:SUITE 1B
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07302-3848
Mailing Address - Country:US
Mailing Address - Phone:201-204-0737
Mailing Address - Fax:
Practice Address - Street 1:105 GREENE ST
Practice Address - Street 2:SUITE 1B
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07302-3848
Practice Address - Country:US
Practice Address - Phone:201-204-0737
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-08
Last Update Date:2008-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI02264800122300000X
NJ22DI02203700122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty