Organization
NORTH BERGEN DENTAL GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PETER FUENTES DMD (PRESIDENT)
(201) 869-3107
Entity
Organization
Contact information
Practice address
7601 BROADWAY, NORTH BERGEN, NJ 07047-5723
(201) 869-3107
Mailing address
7601 BROADWAY, NORTH BERGEN, NJ 07047-5723
(201) 869-3107
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
22907
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0154814
—
NJ
Enumeration date
10/28/2009
Last updated
10/28/2009
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