Provider Demographics
NPI:1760820047
Name:ADVANCED DENTAL CARE OF ENGLEWOOD
Entity Type:Organization
Organization Name:ADVANCED DENTAL CARE OF ENGLEWOOD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ADRIJANA
Authorized Official - Middle Name:
Authorized Official - Last Name:MIKSA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:201-227-3368
Mailing Address - Street 1:177 N DEAN ST STE 206
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07631-2523
Mailing Address - Country:US
Mailing Address - Phone:201-227-3368
Mailing Address - Fax:201-227-3371
Practice Address - Street 1:177 N DEAN ST STE 206
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07631-2523
Practice Address - Country:US
Practice Address - Phone:201-227-3368
Practice Address - Fax:201-227-3371
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-10
Last Update Date:2013-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI02337200261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental