NPIMap

Organization Active NPI

Glen Ridge Cosmetic and Family Dentistry

  • Dentist
  • Glen Ridge, NJ
National Provider Identifier
1083880819
Registry record updated May 1, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
21675 Issued in NJ
Legal business name
GLEN RIDGE COSMETIC AND FAMILY DENTISTRY
Practice address
89 Glen Ridge Ave
Glen Ridge, NJ 07028-1413
Phone
(973) 743-6092
NPI assigned
May 1, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 1, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Louis Theodorou Jr., DMD, FAGDNPI 1376614644
Title
Owner
Phone
(973) 743-6092

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X 21675 NJ Primary

Addresses

Primary practice location

89 Glen Ridge Ave
Glen Ridge, NJ 07028-1413

Mailing address

89 Glen Ridge Ave
Glen Ridge, NJ 07028-1413
Phone (973) 743-6092

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1209600000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1209600000000",
    "number": "1083880819",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "89 GLEN RIDGE AVE",
            "city": "GLEN RIDGE",
            "state": "NJ",
            "postal_code": "070281413",
            "telephone_number": "973-743-6092"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "89 GLEN RIDGE AVE",
            "city": "GLEN RIDGE",
            "state": "NJ",
            "postal_code": "070281413",
            "telephone_number": "973-743-6092"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GLEN RIDGE COSMETIC AND FAMILY DENTISTRY",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-05-01",
        "last_updated": "2008-05-01",
        "status": "A",
        "authorized_official_last_name": "THEODOROU",
        "authorized_official_first_name": "LOUIS",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "973-743-6092",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "DMD, FAGD"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "NJ",
            "license": "21675",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Glen Ridge, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 1, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.