Provider Demographics
NPI:1518015205
Name:PERIODONTICS AND IMPLANTOLOGY ASSOCIATES, P.C.
Entity Type:Organization
Organization Name:PERIODONTICS AND IMPLANTOLOGY ASSOCIATES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:J
Authorized Official - Last Name:GREENBERGER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:973-731-8300
Mailing Address - Street 1:97 NORTHFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:WEST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07052-4723
Mailing Address - Country:US
Mailing Address - Phone:973-731-8300
Mailing Address - Fax:
Practice Address - Street 1:97 NORTHFIELD AVE
Practice Address - Street 2:
Practice Address - City:WEST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07052-4723
Practice Address - Country:US
Practice Address - Phone:973-731-8300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty