Provider Demographics
NPI:1386984243
Name:SUMMIT DENTAL GROUP RIVERDALE LLC
Entity type:Organization
Organization Name:SUMMIT DENTAL GROUP RIVERDALE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEMBER/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:LORINO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:973-342-1233
Mailing Address - Street 1:860 MEADOW LN
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN LAKES
Mailing Address - State:NJ
Mailing Address - Zip Code:07417-1112
Mailing Address - Country:US
Mailing Address - Phone:973-342-1233
Mailing Address - Fax:
Practice Address - Street 1:92 STATE RT 23
Practice Address - Street 2:
Practice Address - City:RIVERDALE
Practice Address - State:NJ
Practice Address - Zip Code:07457-1203
Practice Address - Country:US
Practice Address - Phone:201-891-7400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-28
Last Update Date:2013-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI02140400122300000X
NJ22DI021526001223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty