Provider Demographics
NPI:1396963971
Name:BLAIR SCHACHTEL DENTAL PC
Entity type:Organization
Organization Name:BLAIR SCHACHTEL DENTAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BLAIR
Authorized Official - Middle Name:ADAM
Authorized Official - Last Name:SCHACHTEL
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:973-325-3500
Mailing Address - Street 1:66 EAST MT.PLEASANT AVENUE
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07039
Mailing Address - Country:US
Mailing Address - Phone:973-325-3500
Mailing Address - Fax:
Practice Address - Street 1:66 E MOUNT PLEASANT AVE
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:NJ
Practice Address - Zip Code:07039-3004
Practice Address - Country:US
Practice Address - Phone:973-325-3500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-21
Last Update Date:2015-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI 198341223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty