Provider Demographics
NPI:1639292410
Name:LAFAYETTE FAMILY DENTISTRY MGMT INC
Entity type:Organization
Organization Name:LAFAYETTE FAMILY DENTISTRY MGMT INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:CHERKEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-488-8866
Mailing Address - Street 1:520 SUMMIT AVENUE
Mailing Address - Street 2:
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601
Mailing Address - Country:US
Mailing Address - Phone:201-488-9030
Mailing Address - Fax:201-488-9130
Practice Address - Street 1:540 LAFAYETTE AVENUE
Practice Address - Street 2:
Practice Address - City:HAWTHORNE
Practice Address - State:NJ
Practice Address - Zip Code:07506
Practice Address - Country:US
Practice Address - Phone:973-304-0700
Practice Address - Fax:973-304-2013
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0009890Medicaid