Provider Demographics
NPI:1386860815
Name:NEW WEST CALDWELL DENTAL GROUP PA
Entity Type:Organization
Organization Name:NEW WEST CALDWELL DENTAL GROUP PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOOKKEEPER
Authorized Official - Prefix:
Authorized Official - First Name:ALLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:RAIMI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-769-4897
Mailing Address - Street 1:700 PASSAIC AVE
Mailing Address - Street 2:
Mailing Address - City:WEST CALDWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07006-6408
Mailing Address - Country:US
Mailing Address - Phone:973-227-8188
Mailing Address - Fax:973-299-5151
Practice Address - Street 1:700 PASSAIC AVE
Practice Address - Street 2:
Practice Address - City:WEST CALDWELL
Practice Address - State:NJ
Practice Address - Zip Code:07006-6408
Practice Address - Country:US
Practice Address - Phone:973-227-8188
Practice Address - Fax:973-299-5151
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI020027001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty