Provider Demographics
NPI:1538688395
Name:TENAFLY DENTISTRY LLC
Entity Type:Organization
Organization Name:TENAFLY DENTISTRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LIRON
Authorized Official - Middle Name:
Authorized Official - Last Name:GAMZEH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:443-928-5322
Mailing Address - Street 1:2 DEAN DR STE D
Mailing Address - Street 2:
Mailing Address - City:TENAFLY
Mailing Address - State:NJ
Mailing Address - Zip Code:07670-2870
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2 DEAN DR STE D
Practice Address - Street 2:
Practice Address - City:TENAFLY
Practice Address - State:NJ
Practice Address - Zip Code:07670-2870
Practice Address - Country:US
Practice Address - Phone:201-871-4505
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-13
Last Update Date:2017-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental