# FAMILY DENTAL ASSOCIATES OF BROOKDALE, L.L.C.

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

## Provider details

- **NPI number:** 1871644419
- **Authorized official:** DR. MICHAEL S. PANITCH D.M.D. (MEMBER-OWNER)
- **Authorized official phone:** (973) 338-6667

## Contact information

- **Practice address:** 988 BROAD ST, BLOOMFIELD, NJ 07003-2806
- **Practice address phone:** (973) 338-6667
- **Practice address fax:** (973) 338-1856
- **Mailing address:** 988 BROAD ST, BLOOMFIELD, NJ 07003-2806
- **Mailing address phone:** (973) 338-6667
- **Mailing address fax:** (973) 338-1856

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | 21896 | NJ | Yes |

## Other

- **Enumeration date:** 01/12/2007
- **Last updated:** 06/26/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 21896 | DENTAL LICENSE NUMBER | NJ |