Provider Demographics
NPI:1265075402
Name:SOUTH PATERSON FAMILY DENTISTRY
Entity type:Organization
Organization Name:SOUTH PATERSON FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:ROZEHZADEH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-881-7800
Mailing Address - Street 1:302 HINE ST
Mailing Address - Street 2:106
Mailing Address - City:PATERSON
Mailing Address - State:NJ
Mailing Address - Zip Code:07503
Mailing Address - Country:US
Mailing Address - Phone:973-881-7800
Mailing Address - Fax:973-357-0884
Practice Address - Street 1:302 HINE ST #106
Practice Address - Street 2:
Practice Address - City:PATERSON
Practice Address - State:NJ
Practice Address - Zip Code:07503-0750
Practice Address - Country:US
Practice Address - Phone:973-881-7800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-21
Last Update Date:2019-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty