Provider Demographics
NPI:1780990820
Name:CHILDREN'S DENTISTRY OF PASSAIC LLC
Entity type:Organization
Organization Name:CHILDREN'S DENTISTRY OF PASSAIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PADMA
Authorized Official - Middle Name:
Authorized Official - Last Name:JOSHI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-859-0538
Mailing Address - Street 1:124 GREGORY AVE
Mailing Address - Street 2:SUITE 303
Mailing Address - City:PASSAIC
Mailing Address - State:NJ
Mailing Address - Zip Code:07055-4856
Mailing Address - Country:US
Mailing Address - Phone:973-859-0538
Mailing Address - Fax:862-249-4929
Practice Address - Street 1:124 GREGORY AVE
Practice Address - Street 2:SUITE 303
Practice Address - City:PASSAIC
Practice Address - State:NJ
Practice Address - Zip Code:07055-4856
Practice Address - Country:US
Practice Address - Phone:973-859-0538
Practice Address - Fax:862-249-2949
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-26
Last Update Date:2010-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI020195261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental