Provider Demographics
NPI:1285713032
Name:PARK AVENUE DENTAL PC
Entity type:Organization
Organization Name:PARK AVENUE DENTAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:MINNI
Authorized Official - Middle Name:
Authorized Official - Last Name:SHARMA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:908-757-3200
Mailing Address - Street 1:160 OAK TREE AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH PLAINFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07080-4407
Mailing Address - Country:US
Mailing Address - Phone:908-757-3200
Mailing Address - Fax:908-757-3223
Practice Address - Street 1:160 OAK TREE AVE
Practice Address - Street 2:
Practice Address - City:SOUTH PLAINFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07080-4407
Practice Address - Country:US
Practice Address - Phone:908-757-3200
Practice Address - Fax:908-757-3223
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-03
Last Update Date:2014-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty