Provider Demographics
NPI:1538970207
Name:CALDWELL DENTAL SPA LLC
Entity type:Organization
Organization Name:CALDWELL DENTAL SPA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CORPORATE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:BODRATO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:609-547-3232
Mailing Address - Street 1:155 ROSELAND AVE STE 6
Mailing Address - Street 2:
Mailing Address - City:CALDWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07006-5937
Mailing Address - Country:US
Mailing Address - Phone:973-403-3455
Mailing Address - Fax:973-403-7804
Practice Address - Street 1:155 ROSELAND AVE STE 6
Practice Address - Street 2:
Practice Address - City:CALDWELL
Practice Address - State:NJ
Practice Address - Zip Code:07006-5937
Practice Address - Country:US
Practice Address - Phone:973-403-3455
Practice Address - Fax:973-403-7804
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-14
Last Update Date:2025-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty