Provider Demographics
NPI:1629113584
Name:GARDEN STATE ORTHODONTICS PA
Entity Type:Organization
Organization Name:GARDEN STATE ORTHODONTICS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:HUMMERT
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:973-379-4471
Mailing Address - Street 1:372 MORRIS AVENUE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07081
Mailing Address - Country:US
Mailing Address - Phone:973-379-4471
Mailing Address - Fax:973-379-4470
Practice Address - Street 1:372 MORRIS AVENUE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07081
Practice Address - Country:US
Practice Address - Phone:973-379-4471
Practice Address - Fax:973-379-4470
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI022480001223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty