Provider Demographics
NPI:1942317953
Name:IMMEDIATE DENTAL PC
Entity Type:Organization
Organization Name:IMMEDIATE DENTAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:
Authorized Official - Last Name:NARDEA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:732-222-8516
Mailing Address - Street 1:121 HIGHWAY 36
Mailing Address - Street 2:#100
Mailing Address - City:WEST LONG BRANCH
Mailing Address - State:NJ
Mailing Address - Zip Code:07764
Mailing Address - Country:US
Mailing Address - Phone:732-222-8516
Mailing Address - Fax:732-542-1558
Practice Address - Street 1:121 HIGHWAY 36
Practice Address - Street 2:#100
Practice Address - City:WEST LONG BRANCH
Practice Address - State:NJ
Practice Address - Zip Code:07764
Practice Address - Country:US
Practice Address - Phone:732-222-8516
Practice Address - Fax:732-542-1558
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty