Provider Demographics
NPI:1992929889
Name:FORDS FAMILY DENTAL CARE LLC
Entity type:Organization
Organization Name:FORDS FAMILY DENTAL CARE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STELLA
Authorized Official - Middle Name:
Authorized Official - Last Name:EFTHYMIOU-BACKOS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:732-738-9087
Mailing Address - Street 1:532 NEW BRUNSWICK AVENUE
Mailing Address - Street 2:
Mailing Address - City:FORDS
Mailing Address - State:NJ
Mailing Address - Zip Code:08863
Mailing Address - Country:US
Mailing Address - Phone:732-738-9087
Mailing Address - Fax:732-738-7317
Practice Address - Street 1:532 NEW BRUNSWICK AVE
Practice Address - Street 2:
Practice Address - City:FORDS
Practice Address - State:NJ
Practice Address - Zip Code:08863
Practice Address - Country:US
Practice Address - Phone:732-738-9087
Practice Address - Fax:732-738-7317
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-12
Last Update Date:2009-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI15467122300000X
NJDI16918122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
223148057Medicare UPIN