NPIMap

Organization Active NPI

North Bergen Dental Group

  • General Practice Dentistry
  • North Bergen, NJ
National Provider Identifier
1861728784
Registry record updated Oct 28, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
22907 Issued in NJ
Legal business name
NORTH BERGEN DENTAL GROUP
Practice address
7601 Broadway
North Bergen, NJ 07047-5723
Phone
(201) 869-3107
NPI assigned
Oct 28, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 28, 2009

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

Authorized official

Name
Dr. Peter Fuentes, DMD
Title
President
Phone
(201) 869-3107

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X 22907 NJ Primary

Addresses

Primary practice location

7601 Broadway
North Bergen, NJ 07047-5723

Mailing address

7601 Broadway
North Bergen, NJ 07047-5723
Phone (201) 869-3107

Other identifiers 1

IdentifierTypeStateIssuer
0154814MedicaidNJ

National Provider Directory

National Provider Directory
Tax ID family
Bayonne Family Dental2 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": "1256688000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1256688000000",
    "number": "1861728784",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7601 BROADWAY",
            "city": "NORTH BERGEN",
            "state": "NJ",
            "postal_code": "070475723",
            "telephone_number": "201-869-3107"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7601 BROADWAY",
            "city": "NORTH BERGEN",
            "state": "NJ",
            "postal_code": "070475723",
            "telephone_number": "201-869-3107"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTH BERGEN DENTAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-10-28",
        "last_updated": "2009-10-28",
        "status": "A",
        "authorized_official_last_name": "FUENTES",
        "authorized_official_first_name": "PETER",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "201-869-3107",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "NJ",
            "license": "22907",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0154814",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in North Bergen, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 28, 2009; 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.