Bergen Passaic Periodontal Group, PA

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

License

D11585 Issued in NJ

Legal business name

BERGEN PASSAIC PERIODONTAL GROUP, PA

Practice address

25-15 Fair Lawn Ave
Fair Lawn, NJ 07410-3434

Phone

(201) 791-2200

Fax

(201) 791-6025

NPI assigned

Aug 15, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Terence Jay Smith, DDS

Title

Secretary

Phone

(201) 791-2200

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1155600000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1437162807",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "25-15 FAIR LAWN AVE",
            "city": "FAIR LAWN",
            "state": "NJ",
            "postal_code": "074103434",
            "telephone_number": "201-791-2200",
            "fax_number": "201-791-6025"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25-15 FAIR LAWN AVE",
            "city": "FAIR LAWN",
            "state": "NJ",
            "postal_code": "074103434",
            "telephone_number": "201-791-2200",
            "fax_number": "201-791-6025"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BERGEN PASSAIC PERIODONTAL GROUP, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-15",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "TERENCE",
        "authorized_official_middle_name": "JAY",
        "authorized_official_title_or_position": "SECRETARY",
        "authorized_official_telephone_number": "201-791-2200",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Periodontics",
            "state": "NJ",
            "license": "D11585",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Bergen Arts and Science Charter Schools
• Bergen Chiropractic and Performance
• Bergen County Anesthesia LLC
• Bergen Endocrinology, PC
• Bergen Enterprises Center LLC (North Jersey Recovery Center)
• Bergen Physical Therapy
• Bergen-Passaic Cataract Laser and Surgery Center, LLC (Bergen-Passaic Eye Surgery Center)
• Deborah Dorothea Berger, LPC
• John Lee Berger, MD
• Stephanie Bergery, RN

• Periodontics in Fair Lawn, NJ
• Providers in Fair Lawn, NJ by specialty
• Periodontics 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.