# BERGENLINE DENTAL GROUP

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

## Provider details

- **NPI number:** 1043477565
- **Authorized official:** DR. PETER FUENTES DMD (OWNER/PRESIDENT)
- **Authorized official phone:** (201) 865-5150

## Contact information

- **Practice address:** 3916 BERGENLINE AVE, 2ND FLOOR, UNION CITY, NJ 07087-1612
- **Practice address phone:** (201) 865-5150
- **Practice address fax:** (201) 865-5962
- **Mailing address:** 3916 BERGENLINE AVE, 2ND FLOOR, UNION CITY, NJ 07087-1612
- **Mailing address phone:** (201) 865-5150
- **Mailing address fax:** (201) 865-5962

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 22907 | NJ | Yes |

## Other

- **Enumeration date:** 05/21/2008
- **Last updated:** 05/21/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 0154831 | — | NJ |