Provider Demographics
NPI:1598880296
Name:ALLEN FOREST CROOMS DDS PA
Entity Type:Organization
Organization Name:ALLEN FOREST CROOMS DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT TREASURER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALLEN
Authorized Official - Middle Name:FOREST
Authorized Official - Last Name:CROOMS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS PA
Authorized Official - Phone:973-824-9085
Mailing Address - Street 1:814 SOUTH TENTH STREET
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07108-1501
Mailing Address - Country:US
Mailing Address - Phone:973-824-9085
Mailing Address - Fax:973-621-6447
Practice Address - Street 1:814 SOUTH TENTH STREET
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07108-1501
Practice Address - Country:US
Practice Address - Phone:973-824-9085
Practice Address - Fax:973-621-6447
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22D100662900122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ111225OtherAETNA DMO
NJ1009778OtherHORIZON BCBS
NJ2688808Medicaid