Integrated Dental Aestetics

Primary specialty

DentistTaxonomy code 122300000X

License

10617 Issued in NJ

Legal business name

INTEGRATED DENTAL AESTETICS

Practice address

11 Kiel Ave
Kinnelon, NJ 07405-2549

Phone

(973) 838-4460

Fax

(973) 838-6258

NPI assigned

Jun 16, 2008

Organization subpart

No

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

Authorized official

Name

Mr. Robert A Logan

Title

Dentist/Owner

Phone

(973) 838-4460

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1213574400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1379376000000",
    "number": "1275793085",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11 KIEL AVE",
            "city": "KINNELON",
            "state": "NJ",
            "postal_code": "074052549",
            "telephone_number": "973-838-4460",
            "fax_number": "973-838-6258"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11 KIEL AVE",
            "city": "KINNELON",
            "state": "NJ",
            "postal_code": "074052549",
            "telephone_number": "973-838-4460",
            "fax_number": "973-838-6258"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTEGRATED DENTAL AESTETICS",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-06-16",
        "last_updated": "2013-09-17",
        "status": "A",
        "authorized_official_last_name": "LOGAN",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "DENTIST/OWNER",
        "authorized_official_telephone_number": "973-838-4460",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "NJ",
            "license": "10617",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Laura Ann Haug, MACCCSLP
• Fumitaka Hayashi, PHD, MD
• Home Rehab PT LLC
• Brittany Leigh Hunter, MS, CCC-SLP
• Mario S Ibrahim, PHARMD
• Integrated Medicine & PT
• Dana Ann Jacko, RD
• Kathleen Marie Janocko, PH.D.
• Jo-Ann Szylit, MD
• Gina M Karnisovas, MA, EDS, NCC, LPC

• Dentist in Kinnelon, NJ
• Providers in Kinnelon, NJ by specialty
• Dentist in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 17, 2013; 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.