Organization
BERGENLINE DENTAL GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PETER FUENTES DMD (OWNER/PRESIDENT)
(201) 865-5150
Entity
Organization
Contact information
Practice address
3916 BERGENLINE AVE, 2ND FLOOR, UNION CITY, NJ 07087-1612
(201) 865-5150
(201) 865-5962
Mailing address
3916 BERGENLINE AVE, 2ND FLOOR, UNION CITY, NJ 07087-1612
(201) 865-5150
(201) 865-5962
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
22907
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0154831
—
NJ
Enumeration date
05/21/2008
Last updated
05/21/2008
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