Organization
PATERSON FAMILY DENTAL
Active
Other names
Bergenline Dental Group
Organization subpart
No
Provider details
NPI number
Authorized official
PETER FUENTES DMD (OWNER)
(973) 225-9975
Entity
Organization
Contact information
Practice address
1020 MAIN ST, PATERSON, NJ 07503-2244
(973) 225-9975
Mailing address
1020 MAIN ST, PATERSON, NJ 07503-2244
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
22907
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0154831
—
NJ
Enumeration date
05/22/2013
Last updated
05/22/2013
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