Provider Demographics
NPI:1477609626
Name:UNITED DENTAL GROUP, P.C.
Entity Type:Organization
Organization Name:UNITED DENTAL GROUP, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RAJIV
Authorized Official - Middle Name:K
Authorized Official - Last Name:MANOCHA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:732-636-0838
Mailing Address - Street 1:876 GREEN ST
Mailing Address - Street 2:
Mailing Address - City:ISELIN
Mailing Address - State:NJ
Mailing Address - Zip Code:08830-2102
Mailing Address - Country:US
Mailing Address - Phone:732-636-0838
Mailing Address - Fax:732-636-1155
Practice Address - Street 1:876 GREEN ST
Practice Address - Street 2:
Practice Address - City:ISELIN
Practice Address - State:NJ
Practice Address - Zip Code:08830-2102
Practice Address - Country:US
Practice Address - Phone:732-636-0838
Practice Address - Fax:732-636-1155
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJD182541223G0001X
NJD178581223G0001X
NJD179191223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty