Provider Demographics
NPI:1952424137
Name:DENTIQUE,INC
Entity Type:Organization
Organization Name:DENTIQUE,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ANNU
Authorized Official - Middle Name:
Authorized Official - Last Name:LUTHRA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:201-704-7526
Mailing Address - Street 1:30 AVE AT PORT IMPERIAL
Mailing Address - Street 2:#210
Mailing Address - City:WEST NEW YORK
Mailing Address - State:NJ
Mailing Address - Zip Code:07093-8372
Mailing Address - Country:US
Mailing Address - Phone:201-704-7526
Mailing Address - Fax:201-766-8625
Practice Address - Street 1:70 HUDSON ST
Practice Address - Street 2:PENTHOUSE SUITE
Practice Address - City:HOBOKEN
Practice Address - State:NJ
Practice Address - Zip Code:07030-5630
Practice Address - Country:US
Practice Address - Phone:201-704-7526
Practice Address - Fax:201-766-8625
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI02159500122300000X
NJ22DI02269300122300000X
NJ22DI02252400122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty