Organization Name: | PEDIATRIC DENTISTRY & ORTHODONTICS, LLC |
NPI Number: | 1245341981 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | CARMINE CARLO RUSSO (GENERAL PARTNER) |
Mailing Address: | 6 Prospect St Suite 1a Midland Park |
State: | NJ US |
Postal Code: | 074321606 |
Phone Number: | 2014455555 |
Fax Number: | 2014455057 |
NPI Enumeration Date: | 08/31/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1223P0221X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | X |
State: | |
Taxonomy Type: | Dental Providers |
Taxonomy Classification: | Dentist |
Taxonomy Specialization: | Pediatric Dentistry |
Taxonomy Definition: | An age-defined specialty that provides both primary and comprehensive preventive and therapeutic oral health care for infants and children through adolescence, including those with special health care needs. |