Provider Demographics
NPI:1780783548
Name:ULTIMATE DENTAL OF NORTH BERGEN
Entity type:Organization
Organization Name:ULTIMATE DENTAL OF NORTH BERGEN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:DR
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:HECTOR
Authorized Official - Last Name:ALVAREZ
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:201-869-5156
Mailing Address - Street 1:8135 KENNEDY BLVD
Mailing Address - Street 2:
Mailing Address - City:NORTH BERGEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07047-4243
Mailing Address - Country:US
Mailing Address - Phone:201-869-5156
Mailing Address - Fax:201-869-3891
Practice Address - Street 1:8135 KENNEDY BLVD
Practice Address - Street 2:
Practice Address - City:NORTH BERGEN
Practice Address - State:NJ
Practice Address - Zip Code:07047-4243
Practice Address - Country:US
Practice Address - Phone:201-869-5156
Practice Address - Fax:201-869-3891
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJD119389122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty