Provider Demographics
NPI:1356536379
Name:GALLERIA DENTAL GROUP LLC
Entity type:Organization
Organization Name:GALLERIA DENTAL GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:POLINA
Authorized Official - Middle Name:
Authorized Official - Last Name:BARENBAUM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:732-462-5511
Mailing Address - Street 1:100 ROUTE 9
Mailing Address - Street 2:SUITE11
Mailing Address - City:MANALAPAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07726-3014
Mailing Address - Country:US
Mailing Address - Phone:732-462-5511
Mailing Address - Fax:732-462-5611
Practice Address - Street 1:100 ROUTE 9
Practice Address - Street 2:SUITE11
Practice Address - City:MANALAPAN
Practice Address - State:NJ
Practice Address - Zip Code:07726-3014
Practice Address - Country:US
Practice Address - Phone:732-462-5511
Practice Address - Fax:732-462-5611
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-12
Last Update Date:2007-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI022172001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty