Provider Demographics
NPI:1952511651
Name:ALL QUALITY DENTAL LLP
Entity Type:Organization
Organization Name:ALL QUALITY DENTAL LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DDS OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GRIGORIY
Authorized Official - Middle Name:
Authorized Official - Last Name:YUSUPOV
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:908-527-8688
Mailing Address - Street 1:65 JEFFERSON AVE
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH
Mailing Address - State:NJ
Mailing Address - Zip Code:07201
Mailing Address - Country:US
Mailing Address - Phone:908-527-8688
Mailing Address - Fax:908-527-9399
Practice Address - Street 1:65 JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:ELIZABETH
Practice Address - State:NJ
Practice Address - Zip Code:07201
Practice Address - Country:US
Practice Address - Phone:908-527-8688
Practice Address - Fax:908-527-9399
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI 02237900122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ9070109Medicaid
NJ0026492Medicaid