Provider Demographics
NPI:1528254851
Name:INNOVATIVE DENTISTRY, P.C.
Entity type:Organization
Organization Name:INNOVATIVE DENTISTRY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RAJDEEP
Authorized Official - Middle Name:SINGH
Authorized Official - Last Name:RANDHAWA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:732-882-1700
Mailing Address - Street 1:546 SAINT GEORGES AVE
Mailing Address - Street 2:
Mailing Address - City:RAHWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:07065-2542
Mailing Address - Country:US
Mailing Address - Phone:732-882-1700
Mailing Address - Fax:732-882-1799
Practice Address - Street 1:546 SAINT GEORGES AVE
Practice Address - Street 2:
Practice Address - City:RAHWAY
Practice Address - State:NJ
Practice Address - Zip Code:07065-2542
Practice Address - Country:US
Practice Address - Phone:732-882-1700
Practice Address - Fax:732-882-1799
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-20
Last Update Date:2007-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI02201400122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty