Organization Name: | GEORGE XENAKIS, DDS, PALISADES PARK, LLC |
NPI Number: | 1366836520 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | GEORGE XENAKIS (GENERAL MANAGER) |
Mailing Address: | 261a Broad Ave Palisades Park |
State: | NJ US |
Postal Code: | 07650 |
Phone Number: | 2016763003 |
Fax Number: | 2016762613 |
NPI Enumeration Date: | 03/26/2015 |
NPI Last Update Date: | 07/28/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QD0000X |
License Number: | 22DI01715600 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NJ |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Dental |
Taxonomy Definition: |