Provider Demographics
NPI:1780208322
Name:NEW PROVIDENCE ORTHODONTICS LLC
Entity Type:Organization
Organization Name:NEW PROVIDENCE ORTHODONTICS LLC
Other - Org Name:TERRANA ORTHODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:TERRANA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:862-684-1986
Mailing Address - Street 1:40 HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:WHIPPANY
Mailing Address - State:NJ
Mailing Address - Zip Code:07981-1326
Mailing Address - Country:US
Mailing Address - Phone:862-684-1986
Mailing Address - Fax:
Practice Address - Street 1:65 SOUTH ST FL 2
Practice Address - Street 2:
Practice Address - City:NEW PROVIDENCE
Practice Address - State:NJ
Practice Address - Zip Code:07974-1940
Practice Address - Country:US
Practice Address - Phone:908-838-9220
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-29
Last Update Date:2021-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty