Provider Demographics
NPI:1649441742
Name:ALL AMERICAN DENTAL, P.C
Entity type:Organization
Organization Name:ALL AMERICAN DENTAL, P.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALEKSEY
Authorized Official - Middle Name:
Authorized Official - Last Name:NOVAKHOV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:908-353-5400
Mailing Address - Street 1:1210 RAYMOND BLVD
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07102-2903
Mailing Address - Country:US
Mailing Address - Phone:973-645-0200
Mailing Address - Fax:
Practice Address - Street 1:1210 RAYMOND BLVD
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07102-2903
Practice Address - Country:US
Practice Address - Phone:973-645-0200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ALL AMERICAN DENTAL, P.C
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-03-17
Last Update Date:2008-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI020599001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0119261Medicaid
NJ0030686Medicaid
NJ0146455Medicaid
NJ0020079Medicaid