# ENGLEWOOD DENTIST LLC

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

## Provider details

- **NPI number:** 1447959044
- **Authorized official:** DR. DAVID HANNA DMD (OWNER)
- **Authorized official phone:** (551) 200-1939

## Contact information

- **Practice address:** 115 GRAND AVE, ENGLEWOOD, NJ 07631-3654
- **Practice address phone:** (201) 304-7077
- **Practice address fax:** (201) 304-7077
- **Mailing address:** 115 GRAND AVE, ENGLEWOOD, NJ 07631-3654
- **Mailing address phone:** (201) 304-7077
- **Mailing address fax:** (201) 304-7077

## Taxonomy

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

## Other

- **Enumeration date:** 03/02/2023
- **Last updated:** 03/02/2023

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 22DI02759600 | STATE LICENSE | NJ |