Provider Demographics
NPI:1609106491
Name:ATLANTIC DENTAL ASSOCIATES, LLC
Entity Type:Organization
Organization Name:ATLANTIC DENTAL ASSOCIATES, LLC
Other - Org Name:PLEASANT DENTAL ASSOCIATES
Other - Org Type:Other Name
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:LOUIS
Authorized Official - Middle Name:A
Authorized Official - Last Name:D'ANGELO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:609-953-7123
Mailing Address - Street 1:1400 S NEW RD
Mailing Address - Street 2:
Mailing Address - City:PLEASANTVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08232-3738
Mailing Address - Country:US
Mailing Address - Phone:609-641-5400
Mailing Address - Fax:609-641-4025
Practice Address - Street 1:1400 S NEW RD
Practice Address - Street 2:
Practice Address - City:PLEASANTVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08232-3738
Practice Address - Country:US
Practice Address - Phone:609-641-5400
Practice Address - Fax:609-641-4025
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-30
Last Update Date:2009-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty