Provider Demographics
NPI:1518089689
Name:PARAMUS DENTAL CARE
Entity Type:Organization
Organization Name:PARAMUS DENTAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SCAGLIONE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:201-261-9866
Mailing Address - Street 1:1 SEARS DR
Mailing Address - Street 2:4TH FLOOR
Mailing Address - City:PARAMUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07652-3515
Mailing Address - Country:US
Mailing Address - Phone:201-261-9866
Mailing Address - Fax:201-261-9510
Practice Address - Street 1:1 SEARS DR
Practice Address - Street 2:4TH FLOOR
Practice Address - City:PARAMUS
Practice Address - State:NJ
Practice Address - Zip Code:07652-3515
Practice Address - Country:US
Practice Address - Phone:201-261-9866
Practice Address - Fax:201-261-9510
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3100006Medicaid