Provider Demographics
NPI:1063522456
Name:ALL AMERICAN DENTAL PC
Entity type:Organization
Organization Name:ALL AMERICAN DENTAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ALEKSEY
Authorized Official - Middle Name:
Authorized Official - Last Name:NOVAKHOV
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:908-353-5400
Mailing Address - Street 1:14 WEST WINFIELD SCOTT PLZ
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH
Mailing Address - State:NJ
Mailing Address - Zip Code:07201
Mailing Address - Country:US
Mailing Address - Phone:908-353-5400
Mailing Address - Fax:908-353-7273
Practice Address - Street 1:14 WEST WINFIELD SCOTT PLZ
Practice Address - Street 2:
Practice Address - City:ELIZABETH
Practice Address - State:NJ
Practice Address - Zip Code:07201
Practice Address - Country:US
Practice Address - Phone:908-353-5400
Practice Address - Fax:908-353-7273
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22D1020599001223G0001X
NJ22D1022334001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJD0000129500OtherAMERICHOICE
NJ0030724Medicaid
NJ60016392OtherHORIZON
NJ0020079Medicaid
NJ059900OtherDELTA NJ
NJ1646362OtherUNITED CONCORDIA
NJ00000111700OtherAMERICHOICE
NJ0084646Medicaid
NJ103751OtherPOKAL
NJ900OtherDELTA FLAGSHIP