Provider Demographics
NPI:1497363071
Name:BERGEN PREMIERE DENTISTRY LLC
Entity Type:Organization
Organization Name:BERGEN PREMIERE DENTISTRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EWA
Authorized Official - Middle Name:
Authorized Official - Last Name:CIECIEREGA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:973-699-0808
Mailing Address - Street 1:245 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:RAMSEY
Mailing Address - State:NJ
Mailing Address - Zip Code:07446-1942
Mailing Address - Country:US
Mailing Address - Phone:201-746-4614
Mailing Address - Fax:862-377-6111
Practice Address - Street 1:245 E MAIN ST
Practice Address - Street 2:
Practice Address - City:RAMSEY
Practice Address - State:NJ
Practice Address - Zip Code:07446-1942
Practice Address - Country:US
Practice Address - Phone:201-746-4614
Practice Address - Fax:862-377-6111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-20
Last Update Date:2020-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty