| Bergen Dental Practice, P.c. | |
|
21 Magnolia St Bergenfield NJ 07621-3812 | |
| (201) 385-0013 | |
| (201) 385-0842 |
| Full Name | Bergen Dental Practice, P.c. |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 21 Magnolia St, Bergenfield, New Jersey |
| Authorized Official Name and Position | Mohammed Mansoorul Imam (PRESIDENT) |
| Authorized Official Contact | 2013850013 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Bergen Dental Practice, P.c. 21 Magnolia St Bergenfield NJ 07621-3812 Ph: (201) 385-0013 | Bergen Dental Practice, P.c. 21 Magnolia St Bergenfield NJ 07621-3812 Ph: (201) 385-0013 |
| NPI Number | 1033378575 |
|---|---|
| Provider Enumeration Date | 06/09/2008 |
| Last Update Date | 06/09/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1033378575 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 20895 (New Jersey) | Primary |
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