Provider Demographics
NPI:1497920185
Name:ADRIANA MENDIETTA-SAEBOE DDS PA
Entity Type:Organization
Organization Name:ADRIANA MENDIETTA-SAEBOE DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ADRIANA
Authorized Official - Middle Name:M
Authorized Official - Last Name:SAEBOE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:201-343-1010
Mailing Address - Street 1:283 SUMMIT AVE
Mailing Address - Street 2:
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-1431
Mailing Address - Country:US
Mailing Address - Phone:201-615-7539
Mailing Address - Fax:201-336-0205
Practice Address - Street 1:283 SUMMIT AVE.
Practice Address - Street 2:
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-1431
Practice Address - Country:US
Practice Address - Phone:201-343-1010
Practice Address - Fax:201-343-1038
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-24
Last Update Date:2008-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI0189381223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0005239265OtherAETNA
NJ8942OtherDELTA DENTAL