Provider Demographics
NPI:1215131172
Name:IRIE DENTAL ASSOCIATES LLC
Entity type:Organization
Organization Name:IRIE DENTAL ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RUTH
Authorized Official - Middle Name:ELAINE
Authorized Official - Last Name:PARKIN EDWIN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:973-743-4743
Mailing Address - Street 1:275 BROAD ST
Mailing Address - Street 2:1ST FLOOR
Mailing Address - City:BLOOMFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07003-2724
Mailing Address - Country:US
Mailing Address - Phone:973-743-4743
Mailing Address - Fax:973-743-4780
Practice Address - Street 1:275 BROAD ST
Practice Address - Street 2:1ST FLOOR
Practice Address - City:BLOOMFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07003-2724
Practice Address - Country:US
Practice Address - Phone:973-743-4743
Practice Address - Fax:973-743-4780
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI1231231223G0001X
NJDI021471001223G0001X
NJDIO21723001223P0106X
NJDI205101223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Not Answered1223P0106XDental ProvidersDentistOral and Maxillofacial PathologyGroup - Multi-Specialty
Not Answered1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty