Provider Demographics
NPI:1770192239
Name:EASTERN DENTAL HOLDINGS, LLC
Entity Type:Organization
Organization Name:EASTERN DENTAL HOLDINGS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHWARZ
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:816-953-5400
Mailing Address - Street 1:1030 ST. GEORGES AVENUE
Mailing Address - Street 2:SUITE 304
Mailing Address - City:AVENEL
Mailing Address - State:NJ
Mailing Address - Zip Code:07001-1327
Mailing Address - Country:US
Mailing Address - Phone:732-750-0707
Mailing Address - Fax:732-750-5781
Practice Address - Street 1:1030 ST. GEORGES AVENUE
Practice Address - Street 2:SUITE 304
Practice Address - City:AVENEL
Practice Address - State:NJ
Practice Address - Zip Code:07001-1327
Practice Address - Country:US
Practice Address - Phone:732-750-0707
Practice Address - Fax:732-750-5781
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-30
Last Update Date:2020-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No122300000XDental ProvidersDentistGroup - Multi-Specialty
No1223E0200XDental ProvidersDentistEndodonticsGroup - Multi-Specialty
No1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty
No1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty