Provider Demographics
NPI:1730298613
Name:MODERN DENTAL VISION PC
Entity Type:Organization
Organization Name:MODERN DENTAL VISION PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LEONARD
Authorized Official - Middle Name:
Authorized Official - Last Name:VERTSMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:973-546-7111
Mailing Address - Street 1:6 VILLAGE SQUARE EAST
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07011
Mailing Address - Country:US
Mailing Address - Phone:973-546-7111
Mailing Address - Fax:973-546-5225
Practice Address - Street 1:6 VILLAGE SQ EAST
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07011
Practice Address - Country:US
Practice Address - Phone:973-546-7111
Practice Address - Fax:973-546-5225
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty