Provider Demographics
NPI:1750945473
Name:PROSPECT DENTAL CARE
Entity type:Organization
Organization Name:PROSPECT DENTAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:MAKHOUL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:201-444-9011
Mailing Address - Street 1:145 PROSPECT ST STE 202
Mailing Address - Street 2:
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07450-4493
Mailing Address - Country:US
Mailing Address - Phone:201-444-9011
Mailing Address - Fax:201-857-4676
Practice Address - Street 1:145 PROSPECT ST STE 202
Practice Address - Street 2:
Practice Address - City:RIDGEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07450-4493
Practice Address - Country:US
Practice Address - Phone:201-444-9011
Practice Address - Fax:201-857-4676
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-29
Last Update Date:2019-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty