Liza Dental Management Inc.

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

License

19838 Issued in NJ

Legal business name

LIZA DENTAL MANAGEMENT INC.

Practice address

1219 Liberty Ave
Hillside, NJ 07205-2055

Phone

(908) 352-2207

Fax

(908) 352-2208

NPI assigned

Feb 2, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Alexander Yermolenko, D.D.S.

Title

President

Phone

(908) 352-2207

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1170374400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1356489116",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1219 LIBERTY AVE",
            "city": "HILLSIDE",
            "state": "NJ",
            "postal_code": "072052055",
            "telephone_number": "908-352-2207",
            "fax_number": "908-352-2208"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1219 LIBERTY AVE",
            "city": "HILLSIDE",
            "state": "NJ",
            "postal_code": "072052055",
            "telephone_number": "908-352-2207",
            "fax_number": "908-352-2208"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIZA DENTAL MANAGEMENT INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-02",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "YERMOLENKO",
        "authorized_official_first_name": "ALEXANDER",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "908-352-2207",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "NJ",
            "license": "19838",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Dental Clinic/Center in Hillside, NJ
• Providers in Hillside, NJ by specialty
• Dental Clinic/Center in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.