Provider Demographics
NPI:1396037842
Name:AV DENTAL ASSOCIATES
Entity Type:Organization
Organization Name:AV DENTAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ARASH
Authorized Official - Middle Name:
Authorized Official - Last Name:VAHID
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:734-845-4046
Mailing Address - Street 1:1349 CRANBERRY CT
Mailing Address - Street 2:
Mailing Address - City:MAHWAH
Mailing Address - State:NJ
Mailing Address - Zip Code:07430-2372
Mailing Address - Country:US
Mailing Address - Phone:734-845-4046
Mailing Address - Fax:
Practice Address - Street 1:642 NEWARK AVE
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07306-2380
Practice Address - Country:US
Practice Address - Phone:734-845-4046
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-03
Last Update Date:2011-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI02347500122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty