Provider Demographics
NPI:1710118062
Name:CLIFTON FAMILY DENTAL ASSOCIATES, LLC
Entity Type:Organization
Organization Name:CLIFTON FAMILY DENTAL ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL DENTIST / OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JULIET
Authorized Official - Middle Name:A
Authorized Official - Last Name:SIEGEL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:973-778-2226
Mailing Address - Street 1:735 CLIFTON AVE
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07013-1801
Mailing Address - Country:US
Mailing Address - Phone:973-778-2226
Mailing Address - Fax:973-778-3399
Practice Address - Street 1:735 CLIFTON AVE
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07013-1801
Practice Address - Country:US
Practice Address - Phone:973-778-2226
Practice Address - Fax:973-778-3399
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-04
Last Update Date:2009-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI024063011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty