Provider Demographics
NPI:1558716779
Name:BERGEN FAMILY AND COSMETIC DENTISTRY LLC
Entity Type:Organization
Organization Name:BERGEN FAMILY AND COSMETIC DENTISTRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:ANUNEETI
Authorized Official - Middle Name:
Authorized Official - Last Name:SINGLA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:312-215-0028
Mailing Address - Street 1:46 BERKSHIRE PL
Mailing Address - Street 2:APT # 3
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-7258
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:46 BERKSHIRE PL
Practice Address - Street 2:APT # 3
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-7258
Practice Address - Country:US
Practice Address - Phone:312-215-0028
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-25
Last Update Date:2016-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI025414001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty