NPIMap

Organization Active NPI

Paterson Family Dental

  • Dentist
  • Paterson, NJ
National Provider Identifier
1679919252
Registry record updated May 22, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
22907 Issued in NJ
Legal business name
PATERSON FAMILY DENTAL
Practice address
1020 Main St
Paterson, NJ 07503-2244
Phone
(973) 225-9975
NPI assigned
May 22, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 22, 2013

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

Authorized official

Name
Peter Fuentes, DMD
Title
Owner
Phone
(973) 225-9975

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X 22907 NJ Primary

Addresses

Primary practice location

1020 Main St
Paterson, NJ 07503-2244

Mailing address

1020 Main St
Paterson, NJ 07503-2244

Other identifiers 1

IdentifierTypeStateIssuer
0154831MedicaidNJ

Other names 1

  • Bergenline Dental Group Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Bergenline Dental Group2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1369180800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1369180800000",
    "number": "1679919252",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1020 MAIN ST",
            "city": "PATERSON",
            "state": "NJ",
            "postal_code": "075032244"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1020 MAIN ST",
            "city": "PATERSON",
            "state": "NJ",
            "postal_code": "075032244",
            "telephone_number": "973-225-9975"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PATERSON FAMILY DENTAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-05-22",
        "last_updated": "2013-05-22",
        "status": "A",
        "authorized_official_last_name": "FUENTES",
        "authorized_official_first_name": "PETER",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "973-225-9975",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "NJ",
            "license": "22907",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0154831",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bergenline Dental Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Paterson, NJ

Sources for this page

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