Provider Demographics
NPI:1790878080
Name:EAST MADISON DENTAL CORP., P.C.
Entity Type:Organization
Organization Name:EAST MADISON DENTAL CORP., P.C.
Other - Org Name:EAST MADISON DENTAL, P.C.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NARPAT
Authorized Official - Middle Name:S
Authorized Official - Last Name:JAIN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:201-501-8282
Mailing Address - Street 1:79 E MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:DUMONT
Mailing Address - State:NJ
Mailing Address - Zip Code:07628-2417
Mailing Address - Country:US
Mailing Address - Phone:201-501-8282
Mailing Address - Fax:201-501-8380
Practice Address - Street 1:101 PIERMONT RD
Practice Address - Street 2:
Practice Address - City:TENAFLY
Practice Address - State:NJ
Practice Address - Zip Code:07670
Practice Address - Country:US
Practice Address - Phone:201-501-8282
Practice Address - Fax:201-501-8380
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-01
Last Update Date:2018-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI02460200122300000X
NJ22DI019502061223E0200X
NJ22DI019380001223G0001X
NJ22DI026608021223P0221X
NJ22DI019382091223P0300X
NJ22DI022773001223P0700X
NJ22DI021930031223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No122300000XDental ProvidersDentistGroup - Multi-Specialty
No1223E0200XDental ProvidersDentistEndodonticsGroup - Multi-Specialty
No1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
No1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty
No1223P0700XDental ProvidersDentistProsthodonticsGroup - Multi-Specialty
No1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty