Provider Demographics
NPI:1710129994
Name:DADURIAN DENTAL CARE P.C.
Entity Type:Organization
Organization Name:DADURIAN DENTAL CARE P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MEDINA
Authorized Official - Middle Name:DIANA
Authorized Official - Last Name:DADURIAN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:201-791-4113
Mailing Address - Street 1:2 SEARS DRIVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:PARAMUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07652
Mailing Address - Country:US
Mailing Address - Phone:201-791-4113
Mailing Address - Fax:201-791-2512
Practice Address - Street 1:2 SEARS DRIVE
Practice Address - Street 2:SUITE 102
Practice Address - City:PARAMUS
Practice Address - State:NJ
Practice Address - Zip Code:07652
Practice Address - Country:US
Practice Address - Phone:201-791-4113
Practice Address - Fax:201-791-2512
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-02
Last Update Date:2012-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI 0179571223P0221X
1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty