Provider Demographics
NPI:1689879447
Name:FAIRFIELD FAMILY DENTAL CARE
Entity Type:Organization
Organization Name:FAIRFIELD FAMILY DENTAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:D
Authorized Official - Last Name:GAINES
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:973-227-0861
Mailing Address - Street 1:271 US HIGHWAY 46
Mailing Address - Street 2:SUITE A101
Mailing Address - City:FAIRFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07004-2440
Mailing Address - Country:US
Mailing Address - Phone:973-227-0861
Mailing Address - Fax:973-227-1666
Practice Address - Street 1:271 US HIGHWAY 46
Practice Address - Street 2:SUITE A101
Practice Address - City:FAIRFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07004-2440
Practice Address - Country:US
Practice Address - Phone:973-227-0861
Practice Address - Fax:973-227-1666
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-20
Last Update Date:2013-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ15309261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ=========OtherTIN