Provider Demographics
NPI:1457749657
Name:HERITAGE FAMILY DENTAL LLC
Entity Type:Organization
Organization Name:HERITAGE FAMILY DENTAL LLC
Other - Org Name:PETER FAM DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DOCTOR AND OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:FAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-295-8899
Mailing Address - Street 1:842 ARNOLD AVE
Mailing Address - Street 2:
Mailing Address - City:POINT PLEASANT BORO
Mailing Address - State:NJ
Mailing Address - Zip Code:08742-2457
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:842 ARNOLD AVE
Practice Address - Street 2:
Practice Address - City:POINT PLEASANT BORO
Practice Address - State:NJ
Practice Address - Zip Code:08742-2457
Practice Address - Country:US
Practice Address - Phone:732-295-8899
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-23
Last Update Date:2014-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI 02331300261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental