Provider Demographics
NPI:1720585318
Name:WOODLAND PARK DENTISTRY, LLC
Entity Type:Organization
Organization Name:WOODLAND PARK DENTISTRY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:RIMMA
Authorized Official - Middle Name:CHERNYAKHOVSKAYA
Authorized Official - Last Name:SILVA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:201-446-0232
Mailing Address - Street 1:12 WESTON CT
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-6548
Mailing Address - Country:US
Mailing Address - Phone:201-446-0232
Mailing Address - Fax:
Practice Address - Street 1:279 BROWERTOWN RD STE 104
Practice Address - Street 2:
Practice Address - City:WOODLAND PARK
Practice Address - State:NJ
Practice Address - Zip Code:07424-2663
Practice Address - Country:US
Practice Address - Phone:973-256-3366
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-10
Last Update Date:2018-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI02504800261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental