Provider Demographics
NPI:1881849198
Name:DENTAL DESIGN GROUP
Entity Type:Organization
Organization Name:DENTAL DESIGN GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MILAD
Authorized Official - Middle Name:S
Authorized Official - Last Name:ISSA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:732-354-0707
Mailing Address - Street 1:1303 STATE ROUTE 27
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:NJ
Mailing Address - Zip Code:08873-3456
Mailing Address - Country:US
Mailing Address - Phone:732-354-0707
Mailing Address - Fax:
Practice Address - Street 1:1303 STATE ROUTE 27
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:NJ
Practice Address - Zip Code:08873-3456
Practice Address - Country:US
Practice Address - Phone:732-354-0707
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-01
Last Update Date:2008-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI023842001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty