Provider Demographics
NPI:1639283948
Name:SUBURBAN PERIODONTICS AND IMPLANTS LLC
Entity Type:Organization
Organization Name:SUBURBAN PERIODONTICS AND IMPLANTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:J
Authorized Official - Last Name:GOREN ROBINS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:973-467-5567
Mailing Address - Street 1:75 MAIN STREET
Mailing Address - Street 2:SUITE 107
Mailing Address - City:MILLBURN
Mailing Address - State:NJ
Mailing Address - Zip Code:07041
Mailing Address - Country:US
Mailing Address - Phone:973-467-5567
Mailing Address - Fax:973-467-5639
Practice Address - Street 1:75 MAIN STREET
Practice Address - Street 2:SUITE 107
Practice Address - City:MILLBURN
Practice Address - State:NJ
Practice Address - Zip Code:07041
Practice Address - Country:US
Practice Address - Phone:973-467-5567
Practice Address - Fax:973-467-5639
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-17
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJTIN1223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty