1083129662 NPI number — RAILROAD PLAZA DENTAL ASSOCIATES, LLC DBA PEARLY WHITES

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 1083129662 NPI number — RAILROAD PLAZA DENTAL ASSOCIATES, LLC DBA PEARLY WHITES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RAILROAD PLAZA DENTAL ASSOCIATES, LLC DBA PEARLY WHITES
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:
PEARLY WHITES
Provider Other Organization Name Type Code:
3
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:
1083129662
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/05/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2 RAILROAD PLZ
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WHIPPANY
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07981-1548
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
973-578-8788
Provider Business Mailing Address Fax Number:
973-578-8799

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2 RAILROAD PLZ
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WHIPPANY
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07981-1548
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-578-8788
Provider Business Practice Location Address Fax Number:
973-578-8799
Provider Enumeration Date:
12/05/2017

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SKOLNICK
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
ETHAN
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
973-578-8788

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1223E0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1223G0001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1223P0221X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1223P0300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1223S0112X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1223X0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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