# GLEN RIDGE COSMETIC AND FAMILY DENTISTRY

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

## Provider details

- **NPI number:** 1083880819
- **Authorized official:** LOUIS THEODOROU JR. DMD, FAGD (OWNER)
- **Authorized official phone:** (973) 743-6092

## Contact information

- **Practice address:** 89 GLEN RIDGE AVE, GLEN RIDGE, NJ 07028-1413
- **Practice address phone:** (973) 743-6092
- **Mailing address:** 89 GLEN RIDGE AVE, GLEN RIDGE, NJ 07028-1413
- **Mailing address phone:** (973) 743-6092

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | 21675 | NJ | Yes |

## Other

- **Enumeration date:** 05/01/2008
- **Last updated:** 05/01/2008