Provider Demographics
NPI:1598810772
Name:SUSSEX DENTAL CENTER
Entity Type:Organization
Organization Name:SUSSEX DENTAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:E
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD FAGD
Authorized Official - Phone:973-875-3430
Mailing Address - Street 1:PO BOX 362
Mailing Address - Street 2:
Mailing Address - City:SUSSEX
Mailing Address - State:NJ
Mailing Address - Zip Code:07461-0362
Mailing Address - Country:US
Mailing Address - Phone:973-875-3430
Mailing Address - Fax:973-702-1858
Practice Address - Street 1:359 STATE RT 23
Practice Address - Street 2:
Practice Address - City:SUSSEX
Practice Address - State:NJ
Practice Address - Zip Code:07461-3105
Practice Address - Country:US
Practice Address - Phone:973-875-3430
Practice Address - Fax:973-702-1858
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ=========OtherTAX IDENTIFICATION NUMBER