Provider Demographics
NPI:1619120664
Name:ADVANCED DENTAL LLC
Entity Type:Organization
Organization Name:ADVANCED DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PERIODONTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:D
Authorized Official - Last Name:TSAMBAZIS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:973-586-4444
Mailing Address - Street 1:490 E MAIN ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:DENVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07834-2484
Mailing Address - Country:US
Mailing Address - Phone:973-586-4444
Mailing Address - Fax:973-586-4455
Practice Address - Street 1:490 E MAIN ST
Practice Address - Street 2:
Practice Address - City:DENVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07834-2484
Practice Address - Country:US
Practice Address - Phone:973-586-4444
Practice Address - Fax:973-586-4455
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-03
Last Update Date:2016-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ18218122300000X, 1223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty
No122300000XDental ProvidersDentistGroup - Multi-Specialty