NPIMap

Organization Active NPI

Bergen Pediatric Dental, LLC

  • Pediatric Dentistry
  • Ridgefield Park, NJ
National Provider Identifier
1235323825
Registry record updated Aug 28, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
License
DI19909 Issued in NJ
Legal business name
BERGEN PEDIATRIC DENTAL, LLC
Practice address
45 US Highway 46
Ridgefield Park, NJ 07660-1948
Phone
(201) 440-2100
NPI assigned
Aug 28, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 28, 2007

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

Authorized official

Name
Dmitry StillmanNPI 1275522880
Title
Owner
Phone
(201) 440-2100

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
Pediatric DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223P0221X DI19909 NJ Primary

Addresses

Primary practice location

45 US Highway 46
Ridgefield Park, NJ 07660-1948

Mailing address

45 Winant Ave
Ridgefield Park, NJ 07660

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 3

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": "1188259200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1188259200000",
    "number": "1235323825",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "45 WINANT AVE",
            "city": "RIDGEFIELD PARK",
            "state": "NJ",
            "postal_code": "07660"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "45 US HIGHWAY 46",
            "city": "RIDGEFIELD PARK",
            "state": "NJ",
            "postal_code": "076601948",
            "telephone_number": "201-440-2100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BERGEN PEDIATRIC DENTAL, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-08-28",
        "last_updated": "2007-08-28",
        "status": "A",
        "authorized_official_last_name": "STILLMAN",
        "authorized_official_first_name": "DMITRY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "201-440-2100"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "NJ",
            "license": "DI19909",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ridgefield Park, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 2007; 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.