Provider Demographics
NPI:1740531029
Name:FINE FAMILY DENTAL LLC
Entity type:Organization
Organization Name:FINE FAMILY DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:IRVIN
Authorized Official - Last Name:FINE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:201-569-9393
Mailing Address - Street 1:64 WOODLAND DR
Mailing Address - Street 2:
Mailing Address - City:WOODLAND PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07424-3707
Mailing Address - Country:US
Mailing Address - Phone:973-830-0814
Mailing Address - Fax:
Practice Address - Street 1:240 E PALISADE AVE
Practice Address - Street 2:SUITE 11-C
Practice Address - City:ENGLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07631-3169
Practice Address - Country:US
Practice Address - Phone:201-569-9393
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-26
Last Update Date:2012-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI02318500261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental