NPIMap

Organization Active NPI

Dickerson Dental Group, LLC

  • Dentist
  • Randolph, NJ
National Provider Identifier
1144739244
Registry record updated Sep 21, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
Legal business name
DICKERSON DENTAL GROUP, LLC
Practice address
714 Route 10
Randolph, NJ 07869
Phone
(973) 366-8338
Fax
(973) 366-2178
NPI assigned
Sep 21, 2017
Last updated
Sep 21, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 21, 2017

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

Authorized official

Name
Martine Centrella
Title
Office Manager
Phone
(973) 366-8338

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193200000X MULTI-SPECIALTY GROUP 122300000X Primary

Addresses

Primary practice location

714 Route 10
Randolph, NJ 07869

Mailing address

25-27 Dickerson St.
Dover, NJ 07801
Phone (973) 366-8338

National Provider Directory

National Provider Directory

Locations

25-27 E Dickerson St
Dover, NJ 07801
Phone (973) 366-8338

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1505952000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1505952000000",
    "number": "1144739244",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "25-27 DICKERSON ST.",
            "city": "DOVER",
            "state": "NJ",
            "postal_code": "07801",
            "telephone_number": "973-366-8338",
            "fax_number": "973-366-2178"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "714 ROUTE 10",
            "city": "RANDOLPH",
            "state": "NJ",
            "postal_code": "07869",
            "telephone_number": "973-366-8338",
            "fax_number": "973-366-2178"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DICKERSON DENTAL GROUP, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-09-21",
        "last_updated": "2017-09-21",
        "status": "A",
        "authorized_official_last_name": "CENTRELLA",
        "authorized_official_first_name": "MARTINE",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "973-366-8338"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Randolph, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 21, 2017; 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.