Provider Demographics
NPI:1942481676
Name:SPOTSWOOD FAMILY DENTAL LLC.
Entity Type:Organization
Organization Name:SPOTSWOOD FAMILY DENTAL LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST DDS
Authorized Official - Prefix:DR
Authorized Official - First Name:MAGGIE
Authorized Official - Middle Name:
Authorized Official - Last Name:KASISA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-251-6010
Mailing Address - Street 1:2 AUER CT STE C
Mailing Address - Street 2:
Mailing Address - City:EAST BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08816-5824
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2 AUER CT STE C
Practice Address - Street 2:
Practice Address - City:EAST BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08816-5824
Practice Address - Country:US
Practice Address - Phone:732-251-6010
Practice Address - Fax:732-251-6016
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-22
Last Update Date:2013-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI022099001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty