Provider Demographics
NPI:1932311941
Name:PEDIATRIC DENTAL ASSOCIATES LLC
Entity Type:Organization
Organization Name:PEDIATRIC DENTAL ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:DR
Authorized Official - First Name:SARI
Authorized Official - Middle Name:C
Authorized Official - Last Name:ZIMMER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:201-652-7020
Mailing Address - Street 1:195 SOUTH MAPLE AVE.
Mailing Address - Street 2:
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07450
Mailing Address - Country:US
Mailing Address - Phone:201-652-7020
Mailing Address - Fax:201-652-1550
Practice Address - Street 1:195 SOUTH MAPLE AVE.
Practice Address - Street 2:
Practice Address - City:RIDGEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07450
Practice Address - Country:US
Practice Address - Phone:201-652-7020
Practice Address - Fax:201-652-1550
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ191141223P0221X
NJ220651223P0221X
NJ189211223P0221X
NJ107201223X0400X
NJ98711223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
Not Answered1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty