Provider Demographics
NPI:1831649201
Name:GEORGE XENAKIS, DDS, PALISADES PARK, LLC
Entity Type:Organization
Organization Name:GEORGE XENAKIS, DDS, PALISADES PARK, LLC
Other - Org Name:UNITED DENTAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:XENAKIS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:917-374-5082
Mailing Address - Street 1:1723 ROUTE 27
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08817-3471
Mailing Address - Country:US
Mailing Address - Phone:732-230-2442
Mailing Address - Fax:844-243-1905
Practice Address - Street 1:1723 ROUTE 27
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08817-3471
Practice Address - Country:US
Practice Address - Phone:732-230-2442
Practice Address - Fax:844-243-1905
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-10
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI01715600261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental