Provider Demographics
NPI:1285301333
Name:ADVANCED DENTAL GROUP OF LONG BRANCH PC
Entity type:Organization
Organization Name:ADVANCED DENTAL GROUP OF LONG BRANCH PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FRANCIS
Authorized Official - Middle Name:
Authorized Official - Last Name:OH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-509-1032
Mailing Address - Street 1:PO BOX 1118
Mailing Address - Street 2:
Mailing Address - City:FORT LEE
Mailing Address - State:NJ
Mailing Address - Zip Code:07024-1118
Mailing Address - Country:US
Mailing Address - Phone:201-509-1032
Mailing Address - Fax:
Practice Address - Street 1:107 MONMOUTH RD STE 107
Practice Address - Street 2:
Practice Address - City:WEST LONG BRANCH
Practice Address - State:NJ
Practice Address - Zip Code:07764-1021
Practice Address - Country:US
Practice Address - Phone:201-509-1032
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-26
Last Update Date:2021-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty