Provider Demographics
NPI:1801188982
Name:WAYNE DENTAL ASSOCIATES LLC
Entity Type:Organization
Organization Name:WAYNE DENTAL ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTAL
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:H
Authorized Official - Last Name:SAMER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:973-694-2445
Mailing Address - Street 1:1680 ROUTE 23
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470
Mailing Address - Country:US
Mailing Address - Phone:973-694-2445
Mailing Address - Fax:973-684-5580
Practice Address - Street 1:1680 ROUTE 23
Practice Address - Street 2:SUITE 100
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470
Practice Address - Country:US
Practice Address - Phone:973-694-2445
Practice Address - Fax:973-684-5580
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-09
Last Update Date:2011-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI013953122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty