Provider Demographics
NPI:1740573039
Name:MORRIS COUNTY DENTAL ASSOCIATES, LLC
Entity Type:Organization
Organization Name:MORRIS COUNTY DENTAL ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:IRA
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLDBERG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:973-328-1225
Mailing Address - Street 1:15 COMMERCE BLVD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SUCCASUNNA
Mailing Address - State:NJ
Mailing Address - Zip Code:07876-1343
Mailing Address - Country:US
Mailing Address - Phone:973-328-1225
Mailing Address - Fax:973-328-7650
Practice Address - Street 1:15 COMMERCE BLVD
Practice Address - Street 2:SUITE 201
Practice Address - City:SUCCASUNNA
Practice Address - State:NJ
Practice Address - Zip Code:07876-1343
Practice Address - Country:US
Practice Address - Phone:973-328-1225
Practice Address - Fax:973-328-7650
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-19
Last Update Date:2013-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI0194901223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty