Provider Demographics
NPI:1821227943
Name:MORRIS COUNTY DENTAL SPECIALTY
Entity Type:Organization
Organization Name:MORRIS COUNTY DENTAL SPECIALTY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:NOURBAKHSH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:973-455-1033
Mailing Address - Street 1:453 SPEEDWELL AVE
Mailing Address - Street 2:
Mailing Address - City:MORRIS PLAINS
Mailing Address - State:NJ
Mailing Address - Zip Code:07950-2138
Mailing Address - Country:US
Mailing Address - Phone:973-270-0048
Mailing Address - Fax:973-270-0049
Practice Address - Street 1:453 SPEEDWELL AVE
Practice Address - Street 2:
Practice Address - City:MORRIS PLAINS
Practice Address - State:NJ
Practice Address - Zip Code:07950-2138
Practice Address - Country:US
Practice Address - Phone:973-270-0048
Practice Address - Fax:973-270-0049
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-10
Last Update Date:2009-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI19246261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental