Provider Demographics
NPI:1205251485
Name:DEDICATED MODERN DENTISTRY PC
Entity type:Organization
Organization Name:DEDICATED MODERN DENTISTRY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AGNIESZKA
Authorized Official - Middle Name:
Authorized Official - Last Name:BARA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:732-537-9922
Mailing Address - Street 1:476 UNION AVE
Mailing Address - Street 2:
Mailing Address - City:MIDDLESEX
Mailing Address - State:NJ
Mailing Address - Zip Code:08846-1968
Mailing Address - Country:US
Mailing Address - Phone:732-537-9922
Mailing Address - Fax:732-537-9920
Practice Address - Street 1:476 UNION AVE
Practice Address - Street 2:
Practice Address - City:MIDDLESEX
Practice Address - State:NJ
Practice Address - Zip Code:08846-1968
Practice Address - Country:US
Practice Address - Phone:732-537-9922
Practice Address - Fax:732-537-9920
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-25
Last Update Date:2014-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI025357001223G0001X
NJ22DI021572001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty