Provider Demographics
NPI:1578306668
Name:WHITEHOUSE STATION CENTER FOR DENTISTRY LLC
Entity type:Organization
Organization Name:WHITEHOUSE STATION CENTER FOR DENTISTRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER-GENERAL DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MARINO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:908-534-4001
Mailing Address - Street 1:WHITEHOUSE STATION CENTER FOR DENTISTRY
Mailing Address - Street 2:531 US 22 SUITE 10
Mailing Address - City:WHITEHOUSE STATION
Mailing Address - State:NJ
Mailing Address - Zip Code:08889
Mailing Address - Country:US
Mailing Address - Phone:908-534-4001
Mailing Address - Fax:
Practice Address - Street 1:WHITEHOUSE STATION CENTER FOR DENTISTRY
Practice Address - Street 2:531 US 22 SUITE 10
Practice Address - City:WHITEHOUSE STATION
Practice Address - State:NJ
Practice Address - Zip Code:08889
Practice Address - Country:US
Practice Address - Phone:908-534-4001
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-17
Last Update Date:2024-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental