Provider Demographics
NPI:1467294819
Name:CENTER FOR DENTISTRY OF VERNON LLC
Entity type:Organization
Organization Name:CENTER FOR DENTISTRY OF VERNON LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER - GENERAL DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MARINO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:973-827-0234
Mailing Address - Street 1:5 ROUTE 94 UNIT GH
Mailing Address - Street 2:
Mailing Address - City:VERNON
Mailing Address - State:NJ
Mailing Address - Zip Code:07462-3553
Mailing Address - Country:US
Mailing Address - Phone:973-827-0234
Mailing Address - Fax:973-826-1105
Practice Address - Street 1:5 ROUTE 94 UNIT GH
Practice Address - Street 2:
Practice Address - City:VERNON
Practice Address - State:NJ
Practice Address - Zip Code:07462-3553
Practice Address - Country:US
Practice Address - Phone:973-827-0234
Practice Address - Fax:973-826-1105
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-07
Last Update Date:2024-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental