# PATERSON FAMILY DENTAL

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Bergenline Dental Group
- **Organization subpart:** No

## Provider details

- **NPI number:** 1679919252
- **Authorized official:** PETER FUENTES DMD (OWNER)
- **Authorized official phone:** (973) 225-9975

## Contact information

- **Practice address:** 1020 MAIN ST, PATERSON, NJ 07503-2244
- **Practice address phone:** (973) 225-9975
- **Mailing address:** 1020 MAIN ST, PATERSON, NJ 07503-2244

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | 22907 | NJ | Yes |

## Other

- **Enumeration date:** 05/22/2013
- **Last updated:** 05/22/2013

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 0154831 | — | NJ |