Provider Demographics
NPI:1700335239
Name:TENAFLY DENTAL SPA PC
Entity Type:Organization
Organization Name:TENAFLY DENTAL SPA PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JULIA
Authorized Official - Middle Name:
Authorized Official - Last Name:IGDALEV
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:201-668-0662
Mailing Address - Street 1:464 NEVADA ST
Mailing Address - Street 2:
Mailing Address - City:PARAMUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07652-5622
Mailing Address - Country:US
Mailing Address - Phone:201-668-0662
Mailing Address - Fax:
Practice Address - Street 1:2 DEAN DR
Practice Address - Street 2:3RD FLOOR
Practice Address - City:TENAFLY
Practice Address - State:NJ
Practice Address - Zip Code:07670-2765
Practice Address - Country:US
Practice Address - Phone:201-668-0662
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-26
Last Update Date:2016-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI02013400122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty