Provider Demographics
NPI:1629118146
Name:CONVERY DENTAL ASSOCIATES
Entity Type:Organization
Organization Name:CONVERY DENTAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LUCY
Authorized Official - Middle Name:S
Authorized Official - Last Name:BUCIOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-442-0037
Mailing Address - Street 1:1107 CONVERY BLVD
Mailing Address - Street 2:
Mailing Address - City:PERTH AMBOY
Mailing Address - State:NJ
Mailing Address - Zip Code:00861
Mailing Address - Country:US
Mailing Address - Phone:732-442-0037
Mailing Address - Fax:732-442-3543
Practice Address - Street 1:1107 CONVERY BLVD
Practice Address - Street 2:
Practice Address - City:PERTH AMBOY
Practice Address - State:NJ
Practice Address - Zip Code:00861
Practice Address - Country:US
Practice Address - Phone:732-442-0037
Practice Address - Fax:732-442-3543
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1223G0001X, 1223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Not Answered1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty