Provider Demographics
NPI:1427710003
Name:EJS DENTAL LLC
Entity type:Organization
Organization Name:EJS DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:MAGLIETTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-992-3990
Mailing Address - Street 1:580 S LIVINGSTON AVE
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07039-5411
Mailing Address - Country:US
Mailing Address - Phone:973-992-3990
Mailing Address - Fax:
Practice Address - Street 1:470 RIDGEDALE AVE
Practice Address - Street 2:
Practice Address - City:EAST HANOVER
Practice Address - State:NJ
Practice Address - Zip Code:07936-3074
Practice Address - Country:US
Practice Address - Phone:973-992-3990
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-11
Last Update Date:2021-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental