Provider Demographics
NPI:1538187141
Name:WEST WASHINGTON FAMILY DENTISTRY LLC
Entity type:Organization
Organization Name:WEST WASHINGTON FAMILY DENTISTRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MEGHADRI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:908-835-0800
Mailing Address - Street 1:7 E WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07882-1912
Mailing Address - Country:US
Mailing Address - Phone:908-835-0800
Mailing Address - Fax:908-835-8952
Practice Address - Street 1:7 E WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:NJ
Practice Address - Zip Code:07882-1912
Practice Address - Country:US
Practice Address - Phone:908-835-0800
Practice Address - Fax:908-835-8952
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ9051007Medicaid