Provider Demographics
NPI:1497180038
Name:HAWTHORNE DENTAL ASSOCIATES PC
Entity Type:Organization
Organization Name:HAWTHORNE DENTAL ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSENSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:973-423-4841
Mailing Address - Street 1:625 LAFAYETTE AVE
Mailing Address - Street 2:
Mailing Address - City:HAWTHORNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07506-3401
Mailing Address - Country:US
Mailing Address - Phone:973-423-4841
Mailing Address - Fax:973-423-4840
Practice Address - Street 1:625 LAFAYETTE AVE
Practice Address - Street 2:
Practice Address - City:HAWTHORNE
Practice Address - State:NJ
Practice Address - Zip Code:07506-3401
Practice Address - Country:US
Practice Address - Phone:973-423-4841
Practice Address - Fax:973-423-4840
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-13
Last Update Date:2013-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty