# CENTER FOR DENTISTRY AT HUMC

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

## Provider details

- **NPI number:** 1104091644
- **Authorized official:** DR. MICHAEL BEALS DDS (MNG. DIRECTOR, CENTER FOR DENTISTRY)
- **Authorized official phone:** (201) 996-5674

## Contact information

- **Practice address:** 30 PROSPECT AVE, HACKENSACK, NJ 07601-1914
- **Practice address phone:** (201) 996-2111
- **Practice address fax:** (201) 996-2334
- **Mailing address:** 30 PROSPECT AVE, HACKENSACK, NJ 07601-1914
- **Mailing address phone:** (201) 996-2111
- **Mailing address fax:** (201) 996-2434

## Taxonomy

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

## Other

- **Enumeration date:** 04/25/2008
- **Last updated:** 04/25/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 0137456 | — | NJ |