Provider Demographics
NPI:1245871029
Name:NU DENTAL PC
Entity type:Organization
Organization Name:NU DENTAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ADMASU
Authorized Official - Middle Name:N
Authorized Official - Last Name:GIZAHEW
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:718-568-0405
Mailing Address - Street 1:16 RIVERSIDE LN
Mailing Address - Street 2:
Mailing Address - City:HOLMDEL
Mailing Address - State:NJ
Mailing Address - Zip Code:07733-2084
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:76 POND ST
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10309-1797
Practice Address - Country:US
Practice Address - Phone:718-568-0405
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-03
Last Update Date:2019-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental