Provider Demographics
NPI:1891175253
Name:WAYNE FAMILY DENTAL
Entity Type:Organization
Organization Name:WAYNE FAMILY DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:CHOE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:973-694-4497
Mailing Address - Street 1:931 HAMBURG TPKE
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-3222
Mailing Address - Country:US
Mailing Address - Phone:973-694-4494
Mailing Address - Fax:973-694-4495
Practice Address - Street 1:931 HAMBURG TPKE
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-3222
Practice Address - Country:US
Practice Address - Phone:973-694-4494
Practice Address - Fax:973-694-4495
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-01
Last Update Date:2015-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI020028261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental