Provider Demographics
NPI:1962551465
Name:RENAISSANCE DENTAL CARE LLC
Entity type:Organization
Organization Name:RENAISSANCE DENTAL CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MADHAVI
Authorized Official - Middle Name:
Authorized Official - Last Name:KALUSKAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-422-1400
Mailing Address - Street 1:1520 US HIGHWAY 130 N
Mailing Address - Street 2:SUITE 102
Mailing Address - City:NORTH BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08902-3148
Mailing Address - Country:US
Mailing Address - Phone:732-422-1400
Mailing Address - Fax:
Practice Address - Street 1:1520 US HIGHWAY 130
Practice Address - Street 2:SUITE 102
Practice Address - City:NORTH BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08902-3148
Practice Address - Country:US
Practice Address - Phone:732-422-1400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI212151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty