Provider Demographics
NPI:1760244479
Name:INFINITY DENTAL WELLNESS LLC
Entity Type:Organization
Organization Name:INFINITY DENTAL WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DDS
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ODINSKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-509-0360
Mailing Address - Street 1:86 MORGAN ST
Mailing Address - Street 2:
Mailing Address - City:BERGENFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07621-3515
Mailing Address - Country:US
Mailing Address - Phone:516-509-0360
Mailing Address - Fax:
Practice Address - Street 1:327 BRIDGE PLZ N
Practice Address - Street 2:
Practice Address - City:FORT LEE
Practice Address - State:NJ
Practice Address - Zip Code:07024-5051
Practice Address - Country:US
Practice Address - Phone:201-429-0097
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-29
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty