1477632289 NPI number — DENTAL HEALTH ASSOCIATES PA

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477632289 NPI number — DENTAL HEALTH ASSOCIATES PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DENTAL HEALTH ASSOCIATES PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1477632289
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
320 S MAIN STREET
Provider Second Line Business Mailing Address:
2ND FLR
Provider Business Mailing Address City Name:
PHILLIPSBURG
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08865
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
908-387-6120
Provider Business Mailing Address Fax Number:
908-387-8322

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
320 SOUTH MAIN STREET
Provider Second Line Business Practice Location Address:
2ND FLR CORPORATE OFFICE
Provider Business Practice Location Address City Name:
PHILLIPSBURG
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08865
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
908-387-6120
Provider Business Practice Location Address Fax Number:
908-387-8322
Provider Enumeration Date:
11/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LISMAN
Authorized Official First Name:
CLIFFORD
Authorized Official Middle Name:
G
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
908-387-6120

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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