Family Care Dental Professional Association

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

22DI02134100 Issued in NJ

Legal business name

FAMILY CARE DENTAL PROFESSIONAL ASSOCIATION

Practice address

340 West Passaic Street
Rochelle Park, NJ 07662-3018

Phone

(201) 845-7330

Fax

(201) 845-7339

NPI assigned

Jul 22, 2008

Organization subpart

No

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

Authorized official

Name

Henry Ellis III

Title

Office Manager

Phone

(201) 845-7330

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1216684800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1216684800000",
    "number": "1578728226",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "340 WEST PASSAIC STREET",
            "city": "ROCHELLE PARK",
            "state": "NJ",
            "postal_code": "076623018",
            "telephone_number": "201-845-7330",
            "fax_number": "201-845-7339"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "340 WEST PASSAIC STREET",
            "city": "ROCHELLE PARK",
            "state": "NJ",
            "postal_code": "076623018",
            "telephone_number": "201-845-7330",
            "fax_number": "201-845-7339"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILY CARE DENTAL PROFESSIONAL ASSOCIATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-07-22",
        "last_updated": "2008-07-22",
        "status": "A",
        "authorized_official_last_name": "ELLIS",
        "authorized_official_first_name": "HENRY",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "201-845-7330",
        "authorized_official_name_suffix": "III"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "NJ",
            "license": "22DI02134100",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• General Practice Dentistry in Rochelle Park, NJ
• Providers in Rochelle Park, NJ by specialty
• General Practice Dentistry in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 22, 2008; 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.