Provider Demographics
NPI:1629121629
Name:TOWN CENTER DENTAL L.L.C.
Entity Type:Organization
Organization Name:TOWN CENTER DENTAL L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:MONT RAY
Authorized Official - Middle Name:JOSE
Authorized Official - Last Name:HOLGADO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:609-490-1616
Mailing Address - Street 1:1 WASHINGTON BLVD
Mailing Address - Street 2:SUITE 8
Mailing Address - City:ROBBINSVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08691-3162
Mailing Address - Country:US
Mailing Address - Phone:609-490-1616
Mailing Address - Fax:609-490-1617
Practice Address - Street 1:1 WASHINGTON BLVD
Practice Address - Street 2:SUITE 8
Practice Address - City:ROBBINSVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08691-3162
Practice Address - Country:US
Practice Address - Phone:609-490-1616
Practice Address - Fax:609-490-1617
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental