Provider Demographics
NPI:1467706515
Name:ADVANCED PROSTHODONTICS AND IMPLANT CENTER, LLC
Entity Type:Organization
Organization Name:ADVANCED PROSTHODONTICS AND IMPLANT CENTER, LLC
Other - Org Name:WAYNE HILLS DENTAL, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ASMAHAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:KHATER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:201-220-8224
Mailing Address - Street 1:401 HAMBURG TPKE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-2154
Mailing Address - Country:US
Mailing Address - Phone:201-220-8224
Mailing Address - Fax:
Practice Address - Street 1:401 HAMBURG TPKE
Practice Address - Street 2:SUITE 101
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-2154
Practice Address - Country:US
Practice Address - Phone:201-220-8224
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-27
Last Update Date:2013-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI024254001223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0700XDental ProvidersDentistProsthodonticsGroup - Single Specialty