Provider Demographics
NPI:1831247592
Name:ROCK AVENUE DENTAL, P.C.
Entity type:Organization
Organization Name:ROCK AVENUE DENTAL, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:ZAMIKHOVSKY
Authorized Official - Suffix:
Authorized Official - Credentials:RDA
Authorized Official - Phone:908-754-6444
Mailing Address - Street 1:1300 ROCK AVE
Mailing Address - Street 2:A-4
Mailing Address - City:NORTH PLAINFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07060-3535
Mailing Address - Country:US
Mailing Address - Phone:908-756-6623
Mailing Address - Fax:908-754-7133
Practice Address - Street 1:1300 ROCK AVE
Practice Address - Street 2:A-4
Practice Address - City:NORTH PLAINFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07060-3535
Practice Address - Country:US
Practice Address - Phone:908-756-6623
Practice Address - Fax:908-754-7133
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22D1019163021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty