Provider Demographics
NPI:1053759860
Name:DENTAL DOCTORS OF NJ
Entity type:Organization
Organization Name:DENTAL DOCTORS OF NJ
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:A
Authorized Official - Last Name:FLYNN-NYKTAS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:973-450-0511
Mailing Address - Street 1:136 WASHINGTON AVE
Mailing Address - Street 2:1ST FLR
Mailing Address - City:BELLEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07109-2926
Mailing Address - Country:US
Mailing Address - Phone:973-450-0511
Mailing Address - Fax:
Practice Address - Street 1:136 WASHINGTON AVE
Practice Address - Street 2:1ST FLR
Practice Address - City:BELLEVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07109-2926
Practice Address - Country:US
Practice Address - Phone:973-450-0511
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-13
Last Update Date:2013-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI01712800122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty