Provider Demographics
NPI:1205488780
Name:NOVA PEDIATRIC DENTISTRY
Entity type:Organization
Organization Name:NOVA PEDIATRIC DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:NO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:917-902-7407
Mailing Address - Street 1:1172A 14TH ST
Mailing Address - Street 2:
Mailing Address - City:FORT LEE
Mailing Address - State:NJ
Mailing Address - Zip Code:07024-1658
Mailing Address - Country:US
Mailing Address - Phone:917-902-7407
Mailing Address - Fax:
Practice Address - Street 1:316 KNICKERBOCKER RD
Practice Address - Street 2:
Practice Address - City:DUMONT
Practice Address - State:NJ
Practice Address - Zip Code:07628-1724
Practice Address - Country:US
Practice Address - Phone:201-384-4500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BNJ HOLDINGS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-07-15
Last Update Date:2019-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty