1366858862 NPI number — IRIE DENTAL SPA OF THE ORANGES LLC

Table of content: MR. DAVID EARL NEAL HAD (NPI 1710613344)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366858862 NPI number — IRIE DENTAL SPA OF THE ORANGES LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
IRIE DENTAL SPA OF THE ORANGES LLC
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:
1366858862
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/03/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
15 FREEMAN AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EAST ORANGE
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07018-3429
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
973-673-4743
Provider Business Mailing Address Fax Number:
973-453-8146

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15 FREEMAN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EAST ORANGE
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07018-3429
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-673-4743
Provider Business Practice Location Address Fax Number:
973-453-8146
Provider Enumeration Date:
07/03/2014

Additional Information

Authorized Official

Authorized Official Last Name:
PARKIN
Authorized Official First Name:
RUTH
Authorized Official Middle Name:
Authorized Official Title or Position:
DENTIST
Authorized Official Telephone Number:
973-673-4743

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  DI 20510 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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