Provider Demographics
NPI:1760830293
Name:GEORGE XENAKIS, DDS, PALISADES PARK, LLC
Entity Type:Organization
Organization Name:GEORGE XENAKIS, DDS, PALISADES PARK, LLC
Other - Org Name:UNITED DENTAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:XENAKIS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:212-643-0927
Mailing Address - Street 1:946 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-5136
Mailing Address - Country:US
Mailing Address - Phone:201-464-4783
Mailing Address - Fax:844-631-0047
Practice Address - Street 1:946 MAIN ST
Practice Address - Street 2:
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-5136
Practice Address - Country:US
Practice Address - Phone:201-464-4783
Practice Address - Fax:844-631-0047
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-25
Last Update Date:2016-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI01715600261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental