# ELIZABETH AVENUE DENTAL CTR

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

## Provider details

- **NPI number:** 1538263603
- **Authorized official:** DR. MEHMET S DICKENGIL DDS (PRESIDENT OF CORPORATION)
- **Authorized official phone:** (908) 354-0030

## Contact information

- **Practice address:** 627 ELIZABETH AVENUE, ELIZABETH, NJ 07206
- **Practice address phone:** (908) 354-0030
- **Practice address fax:** (908) 354-4029
- **Mailing address:** 627 ELIZABETH AVENUE, ELIZABETH, NJ 07206
- **Mailing address phone:** (908) 354-0030
- **Mailing address fax:** (908) 354-4029

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | DI15381 | NJ | Yes |

## Other

- **Enumeration date:** 09/11/2006
- **Last updated:** 08/22/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1436805 | — | NJ |