Provider Demographics
NPI:1194934570
Name:SERGE MOLDAVSKY DMD, PC
Entity type:Organization
Organization Name:SERGE MOLDAVSKY DMD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:SERGE
Authorized Official - Middle Name:
Authorized Official - Last Name:MOLDAVSKY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:973-455-0021
Mailing Address - Street 1:31 SOUTH ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:MORRISTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07960-7200
Mailing Address - Country:US
Mailing Address - Phone:973-455-0021
Mailing Address - Fax:
Practice Address - Street 1:31 SOUTH ST
Practice Address - Street 2:SUITE 202
Practice Address - City:MORRISTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07960-7200
Practice Address - Country:US
Practice Address - Phone:973-455-0021
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty