Provider Demographics
NPI:1467473439
Name:IMAGINE ADVANCED DENTAL ARTS PA
Entity Type:Organization
Organization Name:IMAGINE ADVANCED DENTAL ARTS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FINANCIAL CO-ORDINATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:HILT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:609-896-0589
Mailing Address - Street 1:3100 PRINCETON PIKE
Mailing Address - Street 2:BLDG 2 1ST FLOOR
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08648-2300
Mailing Address - Country:US
Mailing Address - Phone:609-896-0589
Mailing Address - Fax:609-895-1591
Practice Address - Street 1:3100 PRINCETON PIKE
Practice Address - Street 2:BLDG 2 1ST FLOOR
Practice Address - City:LAWRENCEVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08648-2300
Practice Address - Country:US
Practice Address - Phone:609-896-0589
Practice Address - Fax:609-895-1591
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2014-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22D1010975001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty