Provider Demographics
NPI:1639555378
Name:HAWORTH DENTAL LLC
Entity Type:Organization
Organization Name:HAWORTH DENTAL LLC
Other - Org Name:HAWORTH DENTAL LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TAL
Authorized Official - Middle Name:J
Authorized Official - Last Name:LEBEL
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:201-384-1717
Mailing Address - Street 1:141 TERRACE ST
Mailing Address - Street 2:
Mailing Address - City:HAWORTH
Mailing Address - State:NJ
Mailing Address - Zip Code:07641-1835
Mailing Address - Country:US
Mailing Address - Phone:201-384-1717
Mailing Address - Fax:201-384-1793
Practice Address - Street 1:141 TERRACE ST
Practice Address - Street 2:
Practice Address - City:HAWORTH
Practice Address - State:NJ
Practice Address - Zip Code:07641-1835
Practice Address - Country:US
Practice Address - Phone:201-384-1717
Practice Address - Fax:201-384-1793
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-05
Last Update Date:2015-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI02497900122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty