Provider Demographics
NPI:1255802435
Name:UTOPIA DENTAL ARTS LLC
Entity type:Organization
Organization Name:UTOPIA DENTAL ARTS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO /OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:
Authorized Official - Last Name:GERGIS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:973-773-5335
Mailing Address - Street 1:426 PASSAIC AVE
Mailing Address - Street 2:
Mailing Address - City:LODI
Mailing Address - State:NJ
Mailing Address - Zip Code:07644-1534
Mailing Address - Country:US
Mailing Address - Phone:973-773-5335
Mailing Address - Fax:
Practice Address - Street 1:426 PASSAIC AVE
Practice Address - Street 2:
Practice Address - City:LODI
Practice Address - State:NJ
Practice Address - Zip Code:07644-1534
Practice Address - Country:US
Practice Address - Phone:973-773-5335
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-16
Last Update Date:2018-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ450322327OtherCIGNA PPO,HUMANA,AETNA PPO, BCBS PPO, METLIFE PPO,