Provider Demographics
NPI:1851847024
Name:NEW JERSEY PERIODONTICS AND DENTAL IMPLANTS LLC
Entity Type:Organization
Organization Name:NEW JERSEY PERIODONTICS AND DENTAL IMPLANTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:S
Authorized Official - Last Name:SILVERSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:814-360-4792
Mailing Address - Street 1:20 ALTAMONT CT
Mailing Address - Street 2:
Mailing Address - City:MORRISTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07960-5325
Mailing Address - Country:US
Mailing Address - Phone:814-360-4792
Mailing Address - Fax:
Practice Address - Street 1:1375 ROUTE 23
Practice Address - Street 2:
Practice Address - City:BUTLER
Practice Address - State:NJ
Practice Address - Zip Code:07405-1733
Practice Address - Country:US
Practice Address - Phone:814-360-4792
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-28
Last Update Date:2016-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI025949001223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty