Provider Demographics
NPI:1124631387
Name:MARIYA MEDLENOV DDS LLC
Entity type:Organization
Organization Name:MARIYA MEDLENOV DDS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARIYA
Authorized Official - Middle Name:
Authorized Official - Last Name:MEDLENOV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:267-288-3355
Mailing Address - Street 1:42 CHATSWORTH RD
Mailing Address - Street 2:
Mailing Address - City:MANALAPAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07726-4187
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:241 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:PINE BEACH
Practice Address - State:NJ
Practice Address - Zip Code:08741-1544
Practice Address - Country:US
Practice Address - Phone:732-341-6010
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-27
Last Update Date:2020-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty