Provider Demographics
NPI:1972212371
Name:PALISADES DENTAL KIDS
Entity Type:Organization
Organization Name:PALISADES DENTAL KIDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:YAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:KRYZMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-882-8055
Mailing Address - Street 1:47 E MADISON AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:DUMONT
Mailing Address - State:NJ
Mailing Address - Zip Code:07628-2417
Mailing Address - Country:US
Mailing Address - Phone:201-308-3795
Mailing Address - Fax:
Practice Address - Street 1:47 E MADISON AVE STE 2
Practice Address - Street 2:
Practice Address - City:DUMONT
Practice Address - State:NJ
Practice Address - Zip Code:07628-2417
Practice Address - Country:US
Practice Address - Phone:201-308-3795
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-15
Last Update Date:2022-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty