Provider Demographics
NPI:1780893651
Name:FAIRFIELD DENTAL CENTER
Entity type:Organization
Organization Name:FAIRFIELD DENTAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DDS
Authorized Official - Prefix:DR
Authorized Official - First Name:SONAL
Authorized Official - Middle Name:M
Authorized Official - Last Name:THAKORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-227-1414
Mailing Address - Street 1:271 US HIGHWAY 46
Mailing Address - Street 2:SUITE D-108
Mailing Address - City:FAIRFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07004-2440
Mailing Address - Country:US
Mailing Address - Phone:973-227-1414
Mailing Address - Fax:973-227-2322
Practice Address - Street 1:271 US HIGHWAY 46
Practice Address - Street 2:SUITE D-108
Practice Address - City:FAIRFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07004-2440
Practice Address - Country:US
Practice Address - Phone:973-227-1414
Practice Address - Fax:973-227-2322
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI0207571223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty