| Advanced Dental Care P.c | |
|
1212 Raymond Blvd Newark NJ 07102 | |
| (973) 645-0200 | |
| Not Available |
| Full Name | Advanced Dental Care P.c |
|---|---|
| Speciality | Dentist |
| Location | 1212 Raymond Blvd, Newark, New Jersey |
| Authorized Official Name and Position | Inessa Alieva (MANAGER) |
| Authorized Official Contact | 9736450200 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Advanced Dental Care P.c 1212 Raymond Blvd Newark NJ 07102 Ph: (973) 645-0200 | Advanced Dental Care P.c 1212 Raymond Blvd Newark NJ 07102 Ph: (973) 645-0200 |
| NPI Number | 1447534755 |
|---|---|
| Provider Enumeration Date | 10/05/2011 |
| Last Update Date | 10/05/2011 |
| Medicare PECOS PAC ID | 6608273032 |
|---|---|
| Medicare Enrollment ID | O20211229000251 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1447534755 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 220102207500 (New Jersey) | Primary |
| Provider Name | Grigoriy Yusupov |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1023279254 PECOS PAC ID: 2860801867 Enrollment ID: I20211229000378 |
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