Provider Demographics
NPI:1558067421
Name:PARAMUS DENTIST LLC
Entity Type:Organization
Organization Name:PARAMUS DENTIST LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:HANNA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:551-200-1939
Mailing Address - Street 1:122 E RIDGEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:PARAMUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07652-4038
Mailing Address - Country:US
Mailing Address - Phone:201-345-3898
Mailing Address - Fax:201-345-3898
Practice Address - Street 1:122 E RIDGEWOOD AVE
Practice Address - Street 2:
Practice Address - City:PARAMUS
Practice Address - State:NJ
Practice Address - Zip Code:07652-4038
Practice Address - Country:US
Practice Address - Phone:201-345-3898
Practice Address - Fax:201-345-3898
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-02
Last Update Date:2023-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ22DI02759600OtherSTATE LICENSE