Provider Demographics
NPI:1598158966
Name:ALL STATE DENTAL LLC
Entity Type:Organization
Organization Name:ALL STATE DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:LUBA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:973-482-3492
Mailing Address - Street 1:546 BLOOMFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07107-1338
Mailing Address - Country:US
Mailing Address - Phone:973-482-3492
Mailing Address - Fax:973-482-3613
Practice Address - Street 1:546 BLOOMFIELD AVE
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07107-1338
Practice Address - Country:US
Practice Address - Phone:973-482-3492
Practice Address - Fax:973-482-3613
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-10
Last Update Date:2015-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI02420900122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty