Provider Demographics
NPI:1639809106
Name:AG DENTAL
Entity Type:Organization
Organization Name:AG DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/GENERAL DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:ARSEN
Authorized Official - Middle Name:
Authorized Official - Last Name:GAZARYAN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:201-492-0997
Mailing Address - Street 1:414 S STOCKBRIDGE CT
Mailing Address - Street 2:
Mailing Address - City:GALLOWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:08205-9685
Mailing Address - Country:US
Mailing Address - Phone:201-892-4995
Mailing Address - Fax:
Practice Address - Street 1:5 E JIMMIE LEEDS RD
Practice Address - Street 2:
Practice Address - City:GALLOWAY
Practice Address - State:NJ
Practice Address - Zip Code:08205-9705
Practice Address - Country:US
Practice Address - Phone:609-646-3890
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-16
Last Update Date:2022-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental