Provider Demographics
NPI:1841569605
Name:OLD BRIDGE DENTAL CARE
Entity Type:Organization
Organization Name:OLD BRIDGE DENTAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:AVI
Authorized Official - Middle Name:
Authorized Official - Last Name:WEISFOGEL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:732-257-5600
Mailing Address - Street 1:30 STATE ROUTE 18
Mailing Address - Street 2:
Mailing Address - City:OLD BRIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:08857-1420
Mailing Address - Country:US
Mailing Address - Phone:732-257-5600
Mailing Address - Fax:
Practice Address - Street 1:30 STATE ROUTE 18
Practice Address - Street 2:
Practice Address - City:OLD BRIDGE
Practice Address - State:NJ
Practice Address - Zip Code:08857-1420
Practice Address - Country:US
Practice Address - Phone:732-257-5600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-23
Last Update Date:2012-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI20783122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty