Provider Demographics
NPI:1891834701
Name:PRINCETON DENTAL, P.A.
Entity type:Organization
Organization Name:PRINCETON DENTAL, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FREDERICK
Authorized Official - Middle Name:W
Authorized Official - Last Name:NIRSCHL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:732-840-1199
Mailing Address - Street 1:900 BROOKSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:OCEAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07712-4144
Mailing Address - Country:US
Mailing Address - Phone:732-663-0873
Mailing Address - Fax:
Practice Address - Street 1:15 PRINCETON AVE
Practice Address - Street 2:
Practice Address - City:BRICK
Practice Address - State:NJ
Practice Address - Zip Code:08724-3515
Practice Address - Country:US
Practice Address - Phone:732-840-1199
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22D1019828001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty