Provider Demographics
NPI:1578949129
Name:ADVANCED DENTAL CONCEPTS PROFESSIONAL ASSOCIATION
Entity Type:Organization
Organization Name:ADVANCED DENTAL CONCEPTS PROFESSIONAL ASSOCIATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHIE LI
Authorized Official - Middle Name:
Authorized Official - Last Name:EE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:609-601-9300
Mailing Address - Street 1:115 E ESSEX AVE
Mailing Address - Street 2:
Mailing Address - City:LINWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08221
Mailing Address - Country:US
Mailing Address - Phone:609-601-9300
Mailing Address - Fax:
Practice Address - Street 1:2106 NEW ROAD
Practice Address - Street 2:SUITE C3
Practice Address - City:LINWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08221
Practice Address - Country:US
Practice Address - Phone:609-601-9300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-06
Last Update Date:2023-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1223G0001X
NJ22DI19786261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDentalGroup - Single Specialty