Provider Demographics
NPI:1023328267
Name:FIRST-CLASS DENTAL PC
Entity type:Organization
Organization Name:FIRST-CLASS DENTAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SERGEY
Authorized Official - Middle Name:
Authorized Official - Last Name:MOLTON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:973-479-3352
Mailing Address - Street 1:596 ANDERSON AVE
Mailing Address - Street 2:SUITE 305
Mailing Address - City:CLIFFSIDE PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07010-1831
Mailing Address - Country:US
Mailing Address - Phone:973-479-3352
Mailing Address - Fax:908-636-2565
Practice Address - Street 1:596 ANDERSON AVE
Practice Address - Street 2:SUITE 305
Practice Address - City:CLIFFSIDE PARK
Practice Address - State:NJ
Practice Address - Zip Code:07010-1831
Practice Address - Country:US
Practice Address - Phone:973-479-3352
Practice Address - Fax:908-636-2565
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-20
Last Update Date:2011-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22D1020304001223G0001X
NY0453591223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ22D102030400OtherNJ
NY045359OtherNY LICENCE #