Aesthetic Dental Center of Hackensack LLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

AESTHETIC DENTAL CENTER OF HACKENSACK LLC

Practice address

161 Main St
Hackensack, NJ 07601

Phone

(201) 488-8866

Fax

(201) 488-7663

NPI assigned

Oct 28, 2008

Organization subpart

No

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

Authorized official

Name

Daria Bagaeva

Title

Office Manager

Phone

(973) 361-6200

Specialties & licenses 1

Addresses

Other names 1

• Pangborn Dental Center LLC Former legal business name

Locations

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

{
    "created_epoch": "1225152000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1575417600000",
    "number": "1154574804",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "163 MAIN ST STE A",
            "city": "HACKENSACK",
            "state": "NJ",
            "postal_code": "076017124",
            "telephone_number": "201-488-8866",
            "fax_number": "201-488-7663"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "161 MAIN ST",
            "city": "HACKENSACK",
            "state": "NJ",
            "postal_code": "07601",
            "telephone_number": "201-488-8866",
            "fax_number": "201-488-7663"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "35 Pangborn Pl",
            "address_purpose": "LOCATION",
            "city": "Hackensack",
            "state": "NJ",
            "postal_code": "076014506",
            "country_code": "US",
            "telephone_number": "201-488-8866",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "AESTHETIC DENTAL CENTER OF HACKENSACK LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-10-28",
        "last_updated": "2019-12-04",
        "status": "A",
        "authorized_official_last_name": "BAGAEVA",
        "authorized_official_first_name": "DARIA",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "973-361-6200"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "NJ",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pangborn Dental Center LLC",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "Pangborn Dental Center LLC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

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• Providers in Hackensack, NJ by specialty
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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 4, 2019; 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.