Provider Demographics
NPI:1871075796
Name:MASTER DENTISTRY CENTER INC
Entity type:Organization
Organization Name:MASTER DENTISTRY CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RAIF
Authorized Official - Middle Name:R
Authorized Official - Last Name:WADI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-861-9440
Mailing Address - Street 1:8412 KENNEDY BLVD
Mailing Address - Street 2:
Mailing Address - City:NORTH BERGEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07047-4265
Mailing Address - Country:US
Mailing Address - Phone:201-758-7834
Mailing Address - Fax:201-758-7837
Practice Address - Street 1:8412 KENNEDY BLVD
Practice Address - Street 2:
Practice Address - City:NORTH BERGEN
Practice Address - State:NJ
Practice Address - Zip Code:07047-4265
Practice Address - Country:US
Practice Address - Phone:201-758-7834
Practice Address - Fax:201-758-7837
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-06
Last Update Date:2022-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No261QS0112XAmbulatory Health Care FacilitiesClinic/CenterOral and Maxillofacial SurgeryGroup - Multi-Specialty