Provider Demographics
NPI:1649673138
Name:YOUR EXPRESSIONS FAMILY DENTISTRY,LLC
Entity type:Organization
Organization Name:YOUR EXPRESSIONS FAMILY DENTISTRY,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:PALLAVI
Authorized Official - Middle Name:
Authorized Official - Last Name:CHELLUR
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:732-297-6111
Mailing Address - Street 1:2864 ROUTE 27
Mailing Address - Street 2:SUITE B
Mailing Address - City:NORTH BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08902-5010
Mailing Address - Country:US
Mailing Address - Phone:732-297-6111
Mailing Address - Fax:732-297-7177
Practice Address - Street 1:2864 ROUTE 27
Practice Address - Street 2:SUITE B
Practice Address - City:NORTH BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08902-5010
Practice Address - Country:US
Practice Address - Phone:732-297-6111
Practice Address - Fax:732-297-7177
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-29
Last Update Date:2014-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI02533400261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental