Provider Demographics
NPI:1699970509
Name:THE ATTENTIVE DENTIST, LLC
Entity type:Organization
Organization Name:THE ATTENTIVE DENTIST, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:GLORIA
Authorized Official - Middle Name:E
Authorized Official - Last Name:PATINO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:862-397-4282
Mailing Address - Street 1:400 S. MAIN ST
Mailing Address - Street 2:1ST FLOOR
Mailing Address - City:WHARTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07885-2043
Mailing Address - Country:US
Mailing Address - Phone:862-397-4282
Mailing Address - Fax:862-397-4285
Practice Address - Street 1:400 S. MAIN ST
Practice Address - Street 2:1ST FLOOR
Practice Address - City:WHARTON
Practice Address - State:NJ
Practice Address - Zip Code:07885-2043
Practice Address - Country:US
Practice Address - Phone:862-397-4282
Practice Address - Fax:862-397-4282
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-19
Last Update Date:2011-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI021553001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty