Provider Demographics
NPI:1366616393
Name:JONATHAN A NITCHE DMD LLC
Entity type:Organization
Organization Name:JONATHAN A NITCHE DMD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:ALBERT
Authorized Official - Last Name:NITCHE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:973-228-5545
Mailing Address - Street 1:556 EAGLE ROCK AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:ROSELAND
Mailing Address - State:NJ
Mailing Address - Zip Code:07068-1503
Mailing Address - Country:US
Mailing Address - Phone:973-228-5545
Mailing Address - Fax:973-228-3863
Practice Address - Street 1:556 EAGLE ROCK AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:ROSELAND
Practice Address - State:NJ
Practice Address - Zip Code:07068-1503
Practice Address - Country:US
Practice Address - Phone:973-228-5545
Practice Address - Fax:973-228-3863
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-22
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ215711223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1700974664OtherINDIVIDUAL NPI
1114941333OtherINDIVIDUAL NPI