Provider Demographics
NPI:1760819569
Name:DENTAL CARE OF VERNON, PA
Entity Type:Organization
Organization Name:DENTAL CARE OF VERNON, PA
Other - Org Name:ADVANCE DENTAL CARE OF VERNON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NIKUNJ
Authorized Official - Middle Name:
Authorized Official - Last Name:ZALAVADIA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:973-209-4944
Mailing Address - Street 1:40 ROUTE 94
Mailing Address - Street 2:VERNON COLONIAL PLAZA
Mailing Address - City:MCAFEE
Mailing Address - State:NJ
Mailing Address - Zip Code:07428
Mailing Address - Country:US
Mailing Address - Phone:973-209-4944
Mailing Address - Fax:
Practice Address - Street 1:40 ROUTE 94
Practice Address - Street 2:VERNON COLONIAL PLAZA
Practice Address - City:MCAFEE
Practice Address - State:NJ
Practice Address - Zip Code:07428
Practice Address - Country:US
Practice Address - Phone:973-209-4944
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-11
Last Update Date:2013-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI02513001122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty