Provider Demographics
NPI:1134253008
Name:AESTHETIC DENTAL CENTER OF MORRIS COUNTY LLC
Entity type:Organization
Organization Name:AESTHETIC DENTAL CENTER OF MORRIS COUNTY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:BAGAEVA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:973-361-6200
Mailing Address - Street 1:600 MOUNT PLEASANT AVE STE E
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:NJ
Mailing Address - Zip Code:07801-1630
Mailing Address - Country:US
Mailing Address - Phone:973-361-6200
Mailing Address - Fax:973-361-4744
Practice Address - Street 1:600 MOUNT PLEASANT AVE STE E
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:NJ
Practice Address - Zip Code:07801-1630
Practice Address - Country:US
Practice Address - Phone:973-361-6200
Practice Address - Fax:973-361-4744
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2019-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QD0000X
NJDI199091223P0221X
NJDI200341223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDentalGroup - Multi-Specialty
Not Answered1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
Not Answered1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty