Provider Demographics
NPI:1457526634
Name:ACADEMY DENTAL ASSOCIATES, P.A.
Entity type:Organization
Organization Name:ACADEMY DENTAL ASSOCIATES, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:D
Authorized Official - Last Name:SILVERSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:201-568-6465
Mailing Address - Street 1:155 N DEAN ST
Mailing Address - Street 2:SUITE 2B
Mailing Address - City:ENGLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07631-2532
Mailing Address - Country:US
Mailing Address - Phone:201-568-6465
Mailing Address - Fax:201-568-7685
Practice Address - Street 1:155 N DEAN ST
Practice Address - Street 2:SUITE 2B
Practice Address - City:ENGLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07631-2532
Practice Address - Country:US
Practice Address - Phone:201-568-6465
Practice Address - Fax:201-568-7685
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-28
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty