Provider Demographics
NPI:1780040014
Name:VANGUARD PERIODONTAL & IMPLANT ASSOCIATES, LLC
Entity Type:Organization
Organization Name:VANGUARD PERIODONTAL & IMPLANT ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:C
Authorized Official - Last Name:WEISS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:973-992-8600
Mailing Address - Street 1:340 E NORTHFIELD RD
Mailing Address - Street 2:SUITE 2A
Mailing Address - City:LIVINGSTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07039-4892
Mailing Address - Country:US
Mailing Address - Phone:973-992-8600
Mailing Address - Fax:973-992-8626
Practice Address - Street 1:340 E NORTHFIELD RD
Practice Address - Street 2:SUITE 2A
Practice Address - City:LIVINGSTON
Practice Address - State:NJ
Practice Address - Zip Code:07039-4892
Practice Address - Country:US
Practice Address - Phone:973-992-9090
Practice Address - Fax:973-992-8626
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-31
Last Update Date:2016-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI018072001223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty