Provider Demographics
NPI:1164859922
Name:LIVINGSTON TOOTH FAIRY FAMILY LLC
Entity type:Organization
Organization Name:LIVINGSTON TOOTH FAIRY FAMILY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARJAN
Authorized Official - Middle Name:
Authorized Official - Last Name:HABIBIAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:732-545-0709
Mailing Address - Street 1:598 LIVINGSTON AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08902-2443
Mailing Address - Country:US
Mailing Address - Phone:732-545-0709
Mailing Address - Fax:
Practice Address - Street 1:598 LIVINGSTON AVE
Practice Address - Street 2:
Practice Address - City:NORTH BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08902-2443
Practice Address - Country:US
Practice Address - Phone:732-545-0709
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-10
Last Update Date:2013-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental