Provider Demographics
NPI:1588112536
Name:DENTISTRY FOR ALL WNY LLC
Entity type:Organization
Organization Name:DENTISTRY FOR ALL WNY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DMD
Authorized Official - Prefix:DR
Authorized Official - First Name:FOROUZAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GHAFFARI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-769-4897
Mailing Address - Street 1:301 KEARNY AVE
Mailing Address - Street 2:DENTAL OFFICE
Mailing Address - City:KEARNY
Mailing Address - State:NJ
Mailing Address - Zip Code:07032-2522
Mailing Address - Country:US
Mailing Address - Phone:973-769-4897
Mailing Address - Fax:
Practice Address - Street 1:5405 BERGENLINE AVE
Practice Address - Street 2:DENTIST OFFICE
Practice Address - City:WEST NEW YORK
Practice Address - State:NJ
Practice Address - Zip Code:07093-4603
Practice Address - Country:US
Practice Address - Phone:973-769-4897
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-20
Last Update Date:2016-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI020027001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty