Provider Demographics
NPI:1851054712
Name:PARAGON DENTAL LLC
Entity Type:Organization
Organization Name:PARAGON DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:INDELICATO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:732-630-0021
Mailing Address - Street 1:1708 HIGHWAY 35
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07748-1832
Mailing Address - Country:US
Mailing Address - Phone:732-630-0021
Mailing Address - Fax:
Practice Address - Street 1:1708 HIGHWAY 35
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:NJ
Practice Address - Zip Code:07748-1832
Practice Address - Country:US
Practice Address - Phone:732-768-9635
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-18
Last Update Date:2022-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental