NPIMap

Organization Active NPI

Englewood Dental, PA

  • General Practice Dentistry
  • Englewood, NJ
National Provider Identifier
1891715330
Registry record updated Sep 13, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
13552 Issued in NJ
Legal business name
ENGLEWOOD DENTAL, PA
Practice address
370 Grand Ave
Suite 200
Englewood, NJ 07631-4154
Phone
(201) 871-3555
Fax
(201) 871-9096
NPI assigned
Jul 20, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 13, 2012

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

Authorized official

Name
Dr. John Carlo Minichetti, DMDNPI 1619990520
Title
President
Phone
(201) 871-3555

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223G0001X 13552 NJ Primary

Addresses

Primary practice location

370 Grand Ave
Suite 200
Englewood, NJ 07631-4154

Mailing address

370 Grand Ave
Suite 200
Englewood, NJ 07631-4154
Phone (201) 871-3555

National Provider Directory

National Provider Directory
Tax ID family
Englewood Dental PA2 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.

Locations

370 Grand Ave
Ste 200
Englewood, NJ 07631
Phone (201) 871-3555

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1153353600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1347494400000",
    "number": "1891715330",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "370 GRAND AVE",
            "address_2": "SUITE 200",
            "city": "ENGLEWOOD",
            "state": "NJ",
            "postal_code": "076314154",
            "telephone_number": "201-871-3555",
            "fax_number": "201-871-9096"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "370 GRAND AVE",
            "address_2": "SUITE 200",
            "city": "ENGLEWOOD",
            "state": "NJ",
            "postal_code": "076314154",
            "telephone_number": "201-871-3555",
            "fax_number": "201-871-9096"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ENGLEWOOD DENTAL, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-20",
        "last_updated": "2012-09-13",
        "status": "A",
        "authorized_official_last_name": "MINICHETTI",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "CARLO",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "201-871-3555",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "NJ",
            "license": "13552",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Englewood, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 13, 2012; 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.