Provider Demographics
NPI:1972727345
Name:BERGENFIELD DENTAL ASSOCIATES
Entity Type:Organization
Organization Name:BERGENFIELD DENTAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EHAB
Authorized Official - Middle Name:TANIOS
Authorized Official - Last Name:SHAHID
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:201-384-0100
Mailing Address - Street 1:29 W CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:BERGENFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07621-1703
Mailing Address - Country:US
Mailing Address - Phone:201-384-0100
Mailing Address - Fax:201-384-3558
Practice Address - Street 1:29 W CHURCH ST
Practice Address - Street 2:
Practice Address - City:BERGENFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07621-1703
Practice Address - Country:US
Practice Address - Phone:201-384-0100
Practice Address - Fax:201-384-3558
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-13
Last Update Date:2008-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI17120122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty