# PANGBORN FAMILY DENTISTRY LLC

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

## Provider details

- **NPI number:** 1982180360
- **Authorized official:** MRS. TWANIQUA CHISOLM (MANAGER)
- **Authorized official phone:** (201) 488-9030

## Contact information

- **Practice address:** 35 PANGBORN PL, HACKENSACK, NJ 07601-4506
- **Practice address phone:** (201) 801-0101
- **Practice address fax:** (201) 488-9130
- **Mailing address:** 520 SUMMIT AVE, HACKENSACK, NJ 07601-1550
- **Mailing address phone:** (201) 488-9030
- **Mailing address fax:** (201) 488-9130

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223E0200X | Endodontics | — | NULL | — |
| 1223E0200X | Endodontics | — | — | — |
| 1223G0001X | General Practice Dentistry | — | NULL | Yes |
| 1223G0001X | General Practice Dentistry | — | — | Yes |
| 1223P0221X | Pediatric Dentistry | — | NULL | — |
| 1223P0221X | Pediatric Dentistry | — | — | — |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | — | NULL | — |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | — | — | — |

## Other

- **Enumeration date:** 07/18/2018
- **Last updated:** 07/18/2018