Provider Demographics
NPI:1457086647
Name:MIDDLESEX FAMILY DENTAL
Entity Type:Organization
Organization Name:MIDDLESEX FAMILY DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MERLIN
Authorized Official - Middle Name:
Authorized Official - Last Name:KURIAKOSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-666-3714
Mailing Address - Street 1:75 PARK GATE DR
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08820-4033
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:77 MAIN ST
Practice Address - Street 2:
Practice Address - City:MIDDLESEX
Practice Address - State:NJ
Practice Address - Zip Code:08846-1513
Practice Address - Country:US
Practice Address - Phone:732-926-1234
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty