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Organization
FAMILY DENTAL ASSOCIATES OF BROOKDALE, L.L.C.
Active
Organization
FAMILY DENTAL ASSOCIATES OF BROOKDALE, L.L.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICHAEL S. PANITCH D.M.D. (MEMBER-OWNER)
(973) 338-6667
Entity
Organization
Contact information
Practice address
988 BROAD ST, BLOOMFIELD, NJ 07003-2806
(973) 338-6667
(973) 338-1856
Mailing address
988 BROAD ST, BLOOMFIELD, NJ 07003-2806
(973) 338-6667
(973) 338-1856
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
21896
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
21896
DENTAL LICENSE NUMBER
NJ
Enumeration date
01/12/2007
Last updated
06/26/2008
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