Provider Demographics
NPI:1912688789
Name:SLOBODIAN DENTAL PC
Entity Type:Organization
Organization Name:SLOBODIAN DENTAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDRII
Authorized Official - Middle Name:
Authorized Official - Last Name:SLOBODIAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:917-753-6453
Mailing Address - Street 1:49 RIDGEDALE AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:EAST HANOVER
Mailing Address - State:NJ
Mailing Address - Zip Code:07936-1014
Mailing Address - Country:US
Mailing Address - Phone:973-822-1200
Mailing Address - Fax:973-822-8454
Practice Address - Street 1:49 RIDGEDALE AVE STE 201
Practice Address - Street 2:
Practice Address - City:EAST HANOVER
Practice Address - State:NJ
Practice Address - Zip Code:07936-1014
Practice Address - Country:US
Practice Address - Phone:973-822-1200
Practice Address - Fax:973-822-8454
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-26
Last Update Date:2023-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty