Provider Demographics
NPI:1841529435
Name:GUTTENBERG FAMILY DENTAL PC
Entity type:Organization
Organization Name:GUTTENBERG FAMILY DENTAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MEHRU
Authorized Official - Middle Name:
Authorized Official - Last Name:BHATIA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:201-861-6000
Mailing Address - Street 1:6800 BERGENLINE AVE
Mailing Address - Street 2:
Mailing Address - City:GUTTENBERG
Mailing Address - State:NJ
Mailing Address - Zip Code:07093-1826
Mailing Address - Country:US
Mailing Address - Phone:201-861-6000
Mailing Address - Fax:201-861-6002
Practice Address - Street 1:6800 BERGENLINE AVE
Practice Address - Street 2:
Practice Address - City:GUTTENBERG
Practice Address - State:NJ
Practice Address - Zip Code:07093-1826
Practice Address - Country:US
Practice Address - Phone:201-861-6000
Practice Address - Fax:201-861-6002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-10
Last Update Date:2009-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI024256001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0212075Medicaid