Provider Demographics
NPI:1972665875
Name:BERGEN PERIODONTIC ASSOC LLC
Entity Type:Organization
Organization Name:BERGEN PERIODONTIC ASSOC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:BASCEANU
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:201-666-2330
Mailing Address - Street 1:333 OLD HOOK ROAD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:WESTWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07675
Mailing Address - Country:US
Mailing Address - Phone:201-666-2330
Mailing Address - Fax:201-666-5043
Practice Address - Street 1:333 OLD HOOK ROAD
Practice Address - Street 2:SUITE 104
Practice Address - City:WESTWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07675
Practice Address - Country:US
Practice Address - Phone:201-666-2330
Practice Address - Fax:201-666-5043
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DIO8426001223P0300X
NJ122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty
Not Answered122300000XDental ProvidersDentistGroup - Multi-Specialty