Provider Demographics
NPI:1548717234
Name:ESSEX DENTAL CARE HEALTH CORP
Entity type:Organization
Organization Name:ESSEX DENTAL CARE HEALTH CORP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KAZUKO
Authorized Official - Middle Name:
Authorized Official - Last Name:NISHISAKI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:610-668-7750
Mailing Address - Street 1:106 N ESSEX AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:NARBERTH
Mailing Address - State:PA
Mailing Address - Zip Code:19072-2233
Mailing Address - Country:US
Mailing Address - Phone:610-668-7750
Mailing Address - Fax:610-668-7750
Practice Address - Street 1:106 N ESSEX AVE
Practice Address - Street 2:SUITE C
Practice Address - City:NARBERTH
Practice Address - State:PA
Practice Address - Zip Code:19072-2233
Practice Address - Country:US
Practice Address - Phone:610-668-7750
Practice Address - Fax:610-668-7750
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-09
Last Update Date:2016-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS037565122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty