# MILL ROAD DENTAL CENTER PC

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

## Provider details

- **NPI number:** 1184789125
- **Authorized official:** YEUGENY AUDEYCHIK DDS (DENTIST)
- **Authorized official phone:** (973) 372-7049

## Contact information

- **Practice address:** 5 MILL ROAD, IRVINGTON, NJ 07111
- **Practice address phone:** (973) 372-7049
- **Practice address fax:** (973) 372-7961
- **Mailing address:** 5 MILL ROAD, IRVINGTON, NJ 07111
- **Mailing address phone:** (973) 372-7049
- **Mailing address fax:** (973) 372-7961

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | 19119 | NJ | — |
| 122300000X | Dentist | 19161 | NJ | Yes |

## Other

- **Enumeration date:** 12/27/2006
- **Last updated:** 05/07/2013

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 636150101 | — | NJ |