Provider Demographics
NPI:1861831083
Name:ORALFACIAL ESTHETICS DENTISTRY, LLC
Entity Type:Organization
Organization Name:ORALFACIAL ESTHETICS DENTISTRY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:201-760-0994
Mailing Address - Street 1:82 E ALLENDALE RD
Mailing Address - Street 2:SUITE 1B
Mailing Address - City:SADDLE RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:07458-3057
Mailing Address - Country:US
Mailing Address - Phone:201-760-0994
Mailing Address - Fax:201-760-0996
Practice Address - Street 1:82 E ALLENDALE RD
Practice Address - Street 2:SUITE 1B
Practice Address - City:SADDLE RIVER
Practice Address - State:NJ
Practice Address - Zip Code:07458-3057
Practice Address - Country:US
Practice Address - Phone:201-760-0994
Practice Address - Fax:201-760-0996
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-20
Last Update Date:2013-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0700XDental ProvidersDentistProsthodonticsGroup - Single Specialty