Provider Demographics
NPI:1316956097
Name:WESTFIELD PEDIATRIC DENTAL GROUP,LLC.
Entity type:Organization
Organization Name:WESTFIELD PEDIATRIC DENTAL GROUP,LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:MCCABE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:908-232-1231
Mailing Address - Street 1:555 WESTFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07090-3375
Mailing Address - Country:US
Mailing Address - Phone:908-232-1231
Mailing Address - Fax:908-232-5525
Practice Address - Street 1:555 WESTFIELD AVE
Practice Address - Street 2:
Practice Address - City:WESTFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07090-3375
Practice Address - Country:US
Practice Address - Phone:908-232-1231
Practice Address - Fax:908-232-5525
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI019153011223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty