Provider Demographics
NPI:1356368039
Name:TAMAR ROODNER DDS, LLC
Entity type:Organization
Organization Name:TAMAR ROODNER DDS, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TAMAR
Authorized Official - Middle Name:
Authorized Official - Last Name:ROODNER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:973-377-2361
Mailing Address - Street 1:50 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:NJ
Mailing Address - Zip Code:07940-1865
Mailing Address - Country:US
Mailing Address - Phone:973-377-2361
Mailing Address - Fax:973-377-2667
Practice Address - Street 1:50 MAIN ST
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:NJ
Practice Address - Zip Code:07940-1865
Practice Address - Country:US
Practice Address - Phone:973-377-2361
Practice Address - Fax:973-377-2667
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI153891223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty