Provider Demographics
NPI:1508257379
Name:DENTAL WELLNESS CENTER
Entity Type:Organization
Organization Name:DENTAL WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:NYMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:AYDIN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:201-306-3515
Mailing Address - Street 1:226 MIDDLE RD STE 2
Mailing Address - Street 2:
Mailing Address - City:HAZLET
Mailing Address - State:NJ
Mailing Address - Zip Code:07730-1946
Mailing Address - Country:US
Mailing Address - Phone:732-264-7615
Mailing Address - Fax:
Practice Address - Street 1:226 MIDDLE RD STE 2
Practice Address - Street 2:
Practice Address - City:HAZLET
Practice Address - State:NJ
Practice Address - Zip Code:07730-1946
Practice Address - Country:US
Practice Address - Phone:732-264-7615
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-13
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDIO2489000122300000X
NJDIO2472800122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty