Provider Demographics
NPI:1720144496
Name:ADAPTIVE DENTAL ASSOCIATES LLC
Entity Type:Organization
Organization Name:ADAPTIVE DENTAL ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:J
Authorized Official - Last Name:MAGGIO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:908-859-4498
Mailing Address - Street 1:755 MEMORIAL PKWY
Mailing Address - Street 2:SUITE 301
Mailing Address - City:PHILLIPSBURG
Mailing Address - State:NJ
Mailing Address - Zip Code:08865-2748
Mailing Address - Country:US
Mailing Address - Phone:908-859-4498
Mailing Address - Fax:908-387-0767
Practice Address - Street 1:755 MEMORIAL PKWY
Practice Address - Street 2:SUITE 301
Practice Address - City:PHILLIPSBURG
Practice Address - State:NJ
Practice Address - Zip Code:08865-2748
Practice Address - Country:US
Practice Address - Phone:908-859-4498
Practice Address - Fax:908-387-0767
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8692009Medicaid