Provider Demographics
NPI:1497909220
Name:ORANGE DENTAL GROUP
Entity Type:Organization
Organization Name:ORANGE DENTAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SALVATORE
Authorized Official - Middle Name:
Authorized Official - Last Name:PAVONE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:973-676-5310
Mailing Address - Street 1:85 S HARRISON ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:EAST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07018-1700
Mailing Address - Country:US
Mailing Address - Phone:973-676-5310
Mailing Address - Fax:973-676-5350
Practice Address - Street 1:85 S HARRISON ST
Practice Address - Street 2:SUITE 103
Practice Address - City:EAST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07018-1700
Practice Address - Country:US
Practice Address - Phone:973-676-5310
Practice Address - Fax:973-676-5350
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-06
Last Update Date:2008-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ236531223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty