Provider Demographics
NPI:1932565041
Name:AMY WAXMAN, D.M.D. PA
Entity Type:Organization
Organization Name:AMY WAXMAN, D.M.D. PA
Other - Org Name:DENTISTRY FOR KIDS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:WAXMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:908-757-3191
Mailing Address - Street 1:4 PROGRESS ST
Mailing Address - Street 2:SUITE B1
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08820-1199
Mailing Address - Country:US
Mailing Address - Phone:908-757-3191
Mailing Address - Fax:
Practice Address - Street 1:4 PROGRESS ST
Practice Address - Street 2:SUITE B1
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08820-1199
Practice Address - Country:US
Practice Address - Phone:908-757-3191
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-05
Last Update Date:2016-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI026038001223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty