Provider Demographics
NPI:1841404431
Name:AESTHETIC DENTAL P.C.
Entity Type:Organization
Organization Name:AESTHETIC DENTAL P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CHITHRA
Authorized Official - Middle Name:
Authorized Official - Last Name:DURGAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-647-5938
Mailing Address - Street 1:769 W END AVE
Mailing Address - Street 2:
Mailing Address - City:CLIFFSIDE PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07010-2129
Mailing Address - Country:US
Mailing Address - Phone:201-943-3033
Mailing Address - Fax:
Practice Address - Street 1:551 ANDERSON AVE
Practice Address - Street 2:
Practice Address - City:CLIFFSIDE PARK
Practice Address - State:NJ
Practice Address - Zip Code:07010-1722
Practice Address - Country:US
Practice Address - Phone:201-943-3033
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ217671223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty