Provider Demographics
NPI:1841406782
Name:LYNDHURST DENTAL MEDICINE, LLC
Entity Type:Organization
Organization Name:LYNDHURST DENTAL MEDICINE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROSS
Authorized Official - Middle Name:
Authorized Official - Last Name:LESSER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:201-933-9092
Mailing Address - Street 1:464 VALLEY BROOK AVE
Mailing Address - Street 2:
Mailing Address - City:LYNDHURST
Mailing Address - State:NJ
Mailing Address - Zip Code:07071-1998
Mailing Address - Country:US
Mailing Address - Phone:201-933-9092
Mailing Address - Fax:201-933-6690
Practice Address - Street 1:464 VALLEY BROOK AVE
Practice Address - Street 2:
Practice Address - City:LYNDHURST
Practice Address - State:NJ
Practice Address - Zip Code:07071-1998
Practice Address - Country:US
Practice Address - Phone:201-933-9092
Practice Address - Fax:201-933-6690
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI17675122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty