Provider Demographics
NPI:1629108782
Name:PRESTIGE DENTAL PC
Entity Type:Organization
Organization Name:PRESTIGE DENTAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OWNER DENTIST
Authorized Official - Prefix:MR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:L
Authorized Official - Last Name:DOKTORMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:973-778-0013
Mailing Address - Street 1:1030 CLIFTON AVE
Mailing Address - Street 2:PRESTIGE DENTAL
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07013
Mailing Address - Country:US
Mailing Address - Phone:973-778-0013
Mailing Address - Fax:973-778-0924
Practice Address - Street 1:1030 CLIFTON AVE
Practice Address - Street 2:PRESTIGE DENTAL
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07013
Practice Address - Country:US
Practice Address - Phone:973-778-0013
Practice Address - Fax:973-778-0924
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty