Provider Demographics
NPI:1124436886
Name:GROUP DENTAL LLC
Entity type:Organization
Organization Name:GROUP DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAHIN
Authorized Official - Middle Name:
Authorized Official - Last Name:GHOBADI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:201-794-1117
Mailing Address - Street 1:479 N MIDLAND AVE STE B
Mailing Address - Street 2:
Mailing Address - City:SADDLE BROOK
Mailing Address - State:NJ
Mailing Address - Zip Code:07663-5597
Mailing Address - Country:US
Mailing Address - Phone:201-794-1117
Mailing Address - Fax:201-794-0364
Practice Address - Street 1:479 N MIDLAND AVE STE B
Practice Address - Street 2:
Practice Address - City:SADDLE BROOK
Practice Address - State:NJ
Practice Address - Zip Code:07663-5597
Practice Address - Country:US
Practice Address - Phone:201-794-1117
Practice Address - Fax:201-794-0364
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-25
Last Update Date:2014-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ=========OtherTAX IDENTIFICATION