# INTEGRATED DENTAL AESTETICS

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

## Provider details

- **NPI number:** 1275793085
- **Authorized official:** MR. ROBERT A LOGAN (DENTIST/OWNER)
- **Authorized official phone:** (973) 838-4460

## Contact information

- **Practice address:** 11 KIEL AVE, KINNELON, NJ 07405-2549
- **Practice address phone:** (973) 838-4460
- **Practice address fax:** (973) 838-6258
- **Mailing address:** 11 KIEL AVE, KINNELON, NJ 07405-2549
- **Mailing address phone:** (973) 838-4460
- **Mailing address fax:** (973) 838-6258

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | 10617 | NJ | Yes |

## Other

- **Enumeration date:** 06/16/2008
- **Last updated:** 09/17/2013