Provider Demographics
NPI:1730626532
Name:AMERICAN FAMILY DENTISTRY PC
Entity type:Organization
Organization Name:AMERICAN FAMILY DENTISTRY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST / OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KUMA
Authorized Official - Middle Name:
Authorized Official - Last Name:KALARIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-444-4932
Mailing Address - Street 1:3562 STATE ROUTE 27
Mailing Address - Street 2:SUITE 115
Mailing Address - City:KENDALL PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:08824-1062
Mailing Address - Country:US
Mailing Address - Phone:732-444-4932
Mailing Address - Fax:
Practice Address - Street 1:3562 STATE ROUTE 27
Practice Address - Street 2:SUITE 115
Practice Address - City:KENDALL PARK
Practice Address - State:NJ
Practice Address - Zip Code:08824-1062
Practice Address - Country:US
Practice Address - Phone:732-444-4932
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-31
Last Update Date:2017-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI02579600122300000X
NJ22DI02406100122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1124424593OtherHEALTH CARE PROVIDER
NJ1750616389OtherHEALTH CARE PROVIDER