Provider Demographics
NPI:1255413506
Name:HUDSON DENTAL ESTHETICS PC
Entity type:Organization
Organization Name:HUDSON DENTAL ESTHETICS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:NOURBAKHSH
Authorized Official - Suffix:
Authorized Official - Credentials:D,D,S
Authorized Official - Phone:201-865-7750
Mailing Address - Street 1:5300 BERGENLINE AVE
Mailing Address - Street 2:
Mailing Address - City:WEST NEW YORK
Mailing Address - State:NJ
Mailing Address - Zip Code:07093-5616
Mailing Address - Country:US
Mailing Address - Phone:201-865-7750
Mailing Address - Fax:201-865-3299
Practice Address - Street 1:5300 BERGENLINE AVE
Practice Address - Street 2:SUITE 8
Practice Address - City:WEST NEW YORK
Practice Address - State:NJ
Practice Address - Zip Code:07093-5616
Practice Address - Country:US
Practice Address - Phone:201-865-7750
Practice Address - Fax:201-865-3299
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI01924600122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty