Provider Demographics
NPI:1447534755
Name:ADVANCED DENTAL CARE P.C
Entity type:Organization
Organization Name:ADVANCED DENTAL CARE P.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:INESSA
Authorized Official - Middle Name:
Authorized Official - Last Name:ALIEVA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-645-0200
Mailing Address - Street 1:1212 RAYMOND BLVD
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07102
Mailing Address - Country:US
Mailing Address - Phone:973-645-0200
Mailing Address - Fax:
Practice Address - Street 1:1212 RAYMOND BLVD
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07102
Practice Address - Country:US
Practice Address - Phone:973-645-0200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-05
Last Update Date:2011-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ220102207500122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty