Provider Demographics
NPI:1407391097
Name:PARK DENTAL ASSOCIATES, INC
Entity Type:Organization
Organization Name:PARK DENTAL ASSOCIATES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALICE
Authorized Official - Middle Name:
Authorized Official - Last Name:SARAYDARIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-945-4411
Mailing Address - Street 1:560 BERGEN BLVD
Mailing Address - Street 2:
Mailing Address - City:RIDGEFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07657-2024
Mailing Address - Country:US
Mailing Address - Phone:201-945-4477
Mailing Address - Fax:201-945-5233
Practice Address - Street 1:560 BERGEN BLVD
Practice Address - Street 2:
Practice Address - City:RIDGEFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07657-2024
Practice Address - Country:US
Practice Address - Phone:201-945-4477
Practice Address - Fax:201-945-5233
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-05
Last Update Date:2017-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI01728600122300000X
NJ22DI01668000122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty