Provider Demographics
NPI:1366535981
Name:DENTAL CENTER OF MONTGOMERY, LLC
Entity type:Organization
Organization Name:DENTAL CENTER OF MONTGOMERY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:C
Authorized Official - Last Name:NAVIN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:609-921-1020
Mailing Address - Street 1:15 TAMARACK CIRCLE
Mailing Address - Street 2:
Mailing Address - City:SKILLMAN
Mailing Address - State:NJ
Mailing Address - Zip Code:08558
Mailing Address - Country:US
Mailing Address - Phone:609-921-1020
Mailing Address - Fax:609-921-2769
Practice Address - Street 1:15 TAMARACK CIRCLE
Practice Address - Street 2:
Practice Address - City:SKILLMAN
Practice Address - State:NJ
Practice Address - Zip Code:08558
Practice Address - Country:US
Practice Address - Phone:609-921-1020
Practice Address - Fax:609-921-2769
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDO131821223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty