Provider Demographics
NPI:1730483496
Name:A-ONE DENTAL LLC
Entity Type:Organization
Organization Name:A-ONE DENTAL LLC
Other - Org Name:CRESTWOOD FAMILY DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SUNDEEP
Authorized Official - Middle Name:C
Authorized Official - Last Name:JOHAL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:732-713-4768
Mailing Address - Street 1:194 PLEASANT VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:MORGANVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07751-4438
Mailing Address - Country:US
Mailing Address - Phone:732-887-8734
Mailing Address - Fax:732-834-9674
Practice Address - Street 1:70 LACEY RD
Practice Address - Street 2:
Practice Address - City:WHITING
Practice Address - State:NJ
Practice Address - Zip Code:08759-2931
Practice Address - Country:US
Practice Address - Phone:732-350-7999
Practice Address - Fax:732-350-7961
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-10
Last Update Date:2011-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ213131223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0021547Medicaid