Provider Demographics
NPI:1598274896
Name:DELUXE DENTAL GROUP LLC
Entity Type:Organization
Organization Name:DELUXE DENTAL GROUP LLC
Other - Org Name:DELUXE DENTAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:GENERAL DENTIST, OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:FRANCIS
Authorized Official - Last Name:SCOTT
Authorized Official - Suffix:IV
Authorized Official - Credentials:DMD
Authorized Official - Phone:732-948-4122
Mailing Address - Street 1:6 THORESEN RD
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:NJ
Mailing Address - Zip Code:07059-7022
Mailing Address - Country:US
Mailing Address - Phone:732-948-4122
Mailing Address - Fax:
Practice Address - Street 1:161 WASHINGTON VALLEY RD STE 202
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:NJ
Practice Address - Zip Code:07059-7177
Practice Address - Country:US
Practice Address - Phone:732-948-4122
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-29
Last Update Date:2017-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI02574700261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental