# BERGEN DENTAL PRACTICE, P.C.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1033378575
- **Authorized official:** DR. MOHAMMED MANSOORUL IMAM DDS (PRESIDENT)
- **Authorized official phone:** (201) 385-0013

## Contact information

- **Practice address:** 21 MAGNOLIA ST, BERGENFIELD, NJ 07621-3812
- **Practice address phone:** (201) 385-0013
- **Practice address fax:** (201) 385-0842
- **Mailing address:** 21 MAGNOLIA ST, BERGENFIELD, NJ 07621-3812
- **Mailing address phone:** (201) 385-0013
- **Mailing address fax:** (201) 385-0842

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 20895 | NJ | Yes |

## Other

- **Enumeration date:** 06/09/2008
- **Last updated:** 06/09/2008