Provider Demographics
NPI:1023268935
Name:DENTAL KIDZ, LIMITED LIABILITY COMPANY
Entity type:Organization
Organization Name:DENTAL KIDZ, LIMITED LIABILITY COMPANY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:HARVELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-204-4006
Mailing Address - Street 1:24 COMMERCE ST
Mailing Address - Street 2:11TH FLOOR
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07102-4060
Mailing Address - Country:US
Mailing Address - Phone:973-204-4006
Mailing Address - Fax:800-757-3051
Practice Address - Street 1:24 COMMERCE ST
Practice Address - Street 2:11TH FLOOR
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07102-4060
Practice Address - Country:US
Practice Address - Phone:973-204-4006
Practice Address - Fax:800-757-3051
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-27
Last Update Date:2008-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty