Provider Demographics
NPI:1609492990
Name:FLDA, LLC
Entity Type:Organization
Organization Name:FLDA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ARASH
Authorized Official - Middle Name:
Authorized Official - Last Name:BASERI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:201-674-6675
Mailing Address - Street 1:43 CORNELL AVE
Mailing Address - Street 2:
Mailing Address - City:BERKELEY HEIGHTS
Mailing Address - State:NJ
Mailing Address - Zip Code:07922-1903
Mailing Address - Country:US
Mailing Address - Phone:201-674-6675
Mailing Address - Fax:
Practice Address - Street 1:25-15 FAIR LAWN AVE
Practice Address - Street 2:
Practice Address - City:FAIR LAWN
Practice Address - State:NJ
Practice Address - Zip Code:07410-3434
Practice Address - Country:US
Practice Address - Phone:201-797-8464
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-22
Last Update Date:2021-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental