Provider Demographics
NPI:1952621625
Name:PENNINGTON DENTAL ARTS, L.L.C.
Entity Type:Organization
Organization Name:PENNINGTON DENTAL ARTS, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GLORIA
Authorized Official - Middle Name:B
Authorized Official - Last Name:GERTZMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:201-924-3296
Mailing Address - Street 1:17 BIGGS PL
Mailing Address - Street 2:
Mailing Address - City:FLEMINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08822-3379
Mailing Address - Country:US
Mailing Address - Phone:201-924-3296
Mailing Address - Fax:
Practice Address - Street 1:2425 PENNINGTON RD
Practice Address - Street 2:SUITE 101
Practice Address - City:PENNINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08534-5228
Practice Address - Country:US
Practice Address - Phone:201-924-3296
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-04
Last Update Date:2010-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22D101185500122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0241709Medicaid