Provider Demographics
NPI:1215310834
Name:IACR DENTAL, PC
Entity type:Organization
Organization Name:IACR DENTAL, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ISELA
Authorized Official - Middle Name:ANA
Authorized Official - Last Name:CANTUARIAS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:201-865-5150
Mailing Address - Street 1:439 60TH ST
Mailing Address - Street 2:
Mailing Address - City:WEST NEW YORK
Mailing Address - State:NJ
Mailing Address - Zip Code:07093-2211
Mailing Address - Country:US
Mailing Address - Phone:201-865-5150
Mailing Address - Fax:201-865-5962
Practice Address - Street 1:439 60TH ST
Practice Address - Street 2:
Practice Address - City:WEST NEW YORK
Practice Address - State:NJ
Practice Address - Zip Code:07093-2211
Practice Address - Country:US
Practice Address - Phone:201-865-5150
Practice Address - Fax:201-865-5962
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-30
Last Update Date:2015-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI024965001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty