# PARK DENTAL ARTS, LLC

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

## Provider details

- **NPI number:** 1578000196
- **Authorized official:** DR. JENI GLAVICIC (CO-OWNER)
- **Authorized official phone:** (201) 945-4477

## Contact information

- **Practice address:** 560 BERGEN BLVD, RIDGEFIELD, NJ 07657
- **Practice address phone:** (201) 945-4477
- **Practice address fax:** (201) 945-5233
- **Mailing address:** 560 BERGEN BLVD, RIDGEFIELD, NJ 07657-2024
- **Mailing address phone:** (201) 945-4477
- **Mailing address fax:** (201) 945-5233

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | DI16680 | NJ | Yes |
| 122300000X | Dentist | DI17286 | NJ | — |

## Other

- **Enumeration date:** 01/20/2017
- **Last updated:** 01/20/2017