Provider Demographics
NPI:1336973262
Name:TRISTATE DENTAL SPA OF PLAINFIELD
Entity type:Organization
Organization Name:TRISTATE DENTAL SPA OF PLAINFIELD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SOKOL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:646-763-3148
Mailing Address - Street 1:153 CLARKEN DR
Mailing Address - Street 2:
Mailing Address - City:WEST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07052-3429
Mailing Address - Country:US
Mailing Address - Phone:646-763-3148
Mailing Address - Fax:
Practice Address - Street 1:400 W FRONT ST STE 2
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07060-1173
Practice Address - Country:US
Practice Address - Phone:646-763-3148
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TRISTATE DENTAL SPA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-09-02
Last Update Date:2024-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty