Provider Demographics
NPI:1013048172
Name:THE CENTER FOR ESTHETIC PERIODONTICS AND IMPLANTOLOGY, LLC
Entity Type:Organization
Organization Name:THE CENTER FOR ESTHETIC PERIODONTICS AND IMPLANTOLOGY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS COORDINATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:H
Authorized Official - Last Name:MILLS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-335-5885
Mailing Address - Street 1:723 N BEERS ST
Mailing Address - Street 2:SUITE 1D
Mailing Address - City:HOLMDEL
Mailing Address - State:NJ
Mailing Address - Zip Code:07733-1517
Mailing Address - Country:US
Mailing Address - Phone:732-335-5885
Mailing Address - Fax:732-335-5886
Practice Address - Street 1:723 N BEERS ST
Practice Address - Street 2:SUITE 1D
Practice Address - City:HOLMDEL
Practice Address - State:NJ
Practice Address - Zip Code:07733-1517
Practice Address - Country:US
Practice Address - Phone:732-335-5885
Practice Address - Fax:732-335-5886
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty