Provider Demographics
NPI:1730102864
Name:DENTISTRY FOR CHILDREN, P.A.
Entity Type:Organization
Organization Name:DENTISTRY FOR CHILDREN, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:CLOONAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-338-1383
Mailing Address - Street 1:382 W PASSAIC AVE
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07003-5552
Mailing Address - Country:US
Mailing Address - Phone:973-338-1383
Mailing Address - Fax:
Practice Address - Street 1:382 W PASSAIC AVE
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07003-5552
Practice Address - Country:US
Practice Address - Phone:973-338-1383
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ107261223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2597608Medicaid