Provider Demographics
NPI:1629862487
Name:KEARNY DENTAL CARE PC
Entity type:Organization
Organization Name:KEARNY DENTAL CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:LAC
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:201-955-0181
Mailing Address - Street 1:17 KEARNY AVE
Mailing Address - Street 2:
Mailing Address - City:KEARNY
Mailing Address - State:NJ
Mailing Address - Zip Code:07032-2332
Mailing Address - Country:US
Mailing Address - Phone:201-955-0181
Mailing Address - Fax:201-955-0181
Practice Address - Street 1:17 KEARNY AVE
Practice Address - Street 2:
Practice Address - City:KEARNY
Practice Address - State:NJ
Practice Address - Zip Code:07032-2332
Practice Address - Country:US
Practice Address - Phone:201-955-0181
Practice Address - Fax:201-955-0181
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-07
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental