Provider Demographics
NPI:1861612012
Name:MEADOWLANDS DENTAL ASSOCIATION
Entity type:Organization
Organization Name:MEADOWLANDS DENTAL ASSOCIATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT - OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:S
Authorized Official - Last Name:DUGAN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:201-933-4747
Mailing Address - Street 1:17 SYLVAN STREET
Mailing Address - Street 2:SUITE 205
Mailing Address - City:RUTHERFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:07070
Mailing Address - Country:US
Mailing Address - Phone:201-933-4747
Mailing Address - Fax:201-933-0744
Practice Address - Street 1:17 SYLVAN STREET
Practice Address - Street 2:SUITE 205
Practice Address - City:RUTHERFORD
Practice Address - State:NJ
Practice Address - Zip Code:07070
Practice Address - Country:US
Practice Address - Phone:201-933-4747
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-30
Last Update Date:2007-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ13815N122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty