Provider Demographics
NPI:1942761499
Name:TRI-STATE DENTISTRY VDE, LLC
Entity Type:Organization
Organization Name:TRI-STATE DENTISTRY VDE, LLC
Other - Org Name:VALUE DENTAL CENTERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAMIK
Authorized Official - Middle Name:N
Authorized Official - Last Name:DESAI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:856-418-5436
Mailing Address - Street 1:1070 W LANDIS AVE
Mailing Address - Street 2:
Mailing Address - City:VINELAND
Mailing Address - State:NJ
Mailing Address - Zip Code:08360-3422
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2000 CLEMENTS BRIDGE RD STE 10
Practice Address - Street 2:
Practice Address - City:DEPTFORD
Practice Address - State:NJ
Practice Address - Zip Code:08096-2016
Practice Address - Country:US
Practice Address - Phone:856-418-5436
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TRI-STATE DENTISTRY, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-03-27
Last Update Date:2019-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
NAOtherNZ