Provider Demographics
NPI:1902154222
Name:NJ DENTAL SPECIALTIES CORP
Entity Type:Organization
Organization Name:NJ DENTAL SPECIALTIES CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:YATIN
Authorized Official - Middle Name:
Authorized Official - Last Name:KHANNA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS FICD
Authorized Official - Phone:718-915-3713
Mailing Address - Street 1:2425 PENNINGTON RD
Mailing Address - Street 2:
Mailing Address - City:PENNINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08534-5228
Mailing Address - Country:US
Mailing Address - Phone:718-915-3713
Mailing Address - Fax:866-894-5881
Practice Address - Street 1:2425 PENNINGTON RD
Practice Address - Street 2:
Practice Address - City:PENNINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08534-5228
Practice Address - Country:US
Practice Address - Phone:718-915-3713
Practice Address - Fax:866-894-5881
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-16
Last Update Date:2012-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ57841223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0700XDental ProvidersDentistProsthodonticsGroup - Multi-Specialty