Provider Demographics
NPI:1619170206
Name:FOR ALL CHILDREN & ADULT DENTISTRY PA
Entity Type:Organization
Organization Name:FOR ALL CHILDREN & ADULT DENTISTRY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FOROUZAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GHAFFARI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:973-769-4897
Mailing Address - Street 1:301 KEARNY AVE
Mailing Address - Street 2:FOR ALL CHIDREN & ADULT DENTISTRY
Mailing Address - City:KEARNY
Mailing Address - State:NJ
Mailing Address - Zip Code:07032-2522
Mailing Address - Country:US
Mailing Address - Phone:973-769-4897
Mailing Address - Fax:973-299-5151
Practice Address - Street 1:301 KEARNY AVE
Practice Address - Street 2:FOR ALL CHIDREN & ADULT DENTISTRY
Practice Address - City:KEARNY
Practice Address - State:NJ
Practice Address - Zip Code:07032-2522
Practice Address - Country:US
Practice Address - Phone:973-769-4897
Practice Address - Fax:973-299-5151
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty