Provider Demographics
NPI:1932470630
Name:SPECIALTY DENTAL INC
Entity Type:Organization
Organization Name:SPECIALTY DENTAL INC
Other - Org Name:HEALTHCHECK DENTAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KEDAR
Authorized Official - Middle Name:N
Authorized Official - Last Name:RUSTOGI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:201-863-0090
Mailing Address - Street 1:4914 KENNEDY BLVD W
Mailing Address - Street 2:SUITE 201
Mailing Address - City:WEST NEW YORK
Mailing Address - State:NJ
Mailing Address - Zip Code:07093-5590
Mailing Address - Country:US
Mailing Address - Phone:201-863-0090
Mailing Address - Fax:201-863-9008
Practice Address - Street 1:1115 INMAN AVE # 191
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08820-1132
Practice Address - Country:US
Practice Address - Phone:908-222-8774
Practice Address - Fax:908-222-8770
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-26
Last Update Date:2012-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI00955000122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty