Provider Demographics
NPI:1902135239
Name:FLEMINGTON DENTAL ASSOCIATES LLC
Entity type:Organization
Organization Name:FLEMINGTON DENTAL ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MOHSEN
Authorized Official - Middle Name:M
Authorized Official - Last Name:NOURBAKHSH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:973-455-1033
Mailing Address - Street 1:111 ROUTE 31
Mailing Address - Street 2:SUITE 211
Mailing Address - City:FLEMINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08822-5795
Mailing Address - Country:US
Mailing Address - Phone:973-455-1033
Mailing Address - Fax:973-455-1263
Practice Address - Street 1:111 ROUTE 31
Practice Address - Street 2:SUITE 211
Practice Address - City:FLEMINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08822-5795
Practice Address - Country:US
Practice Address - Phone:973-455-1033
Practice Address - Fax:973-455-1263
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-16
Last Update Date:2009-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI19246261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental