Provider Demographics
NPI:1770611105
Name:PARK PLACE DENTAL GROUP LLC
Entity type:Organization
Organization Name:PARK PLACE DENTAL GROUP LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:VERONICA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:BIKOFSKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-214-2797
Mailing Address - Street 1:60 PARK PL
Mailing Address - Street 2:SUITE 1107
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07102-5511
Mailing Address - Country:US
Mailing Address - Phone:973-732-3208
Mailing Address - Fax:973-732-3207
Practice Address - Street 1:60 PARK PL
Practice Address - Street 2:SUITE 1107
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07102-5511
Practice Address - Country:US
Practice Address - Phone:973-732-3208
Practice Address - Fax:973-732-3207
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2009-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty