Organization
PANGBORN FAMILY DENTISTRY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. TWANIQUA CHISOLM (MANAGER)
(201) 488-9030
Entity
Organization
Contact information
Practice address
35 PANGBORN PL, HACKENSACK, NJ 07601-4506
(201) 801-0101
(201) 488-9130
Mailing address
520 SUMMIT AVE, HACKENSACK, NJ 07601-1550
(201) 488-9030
(201) 488-9130
Taxonomy
Speciality
Code
Description
License number
State
1223E0200X
Endodontics
—
—
1223G0001X
General Practice Dentistry
Primary
—
—
1223P0221X
Pediatric Dentistry
—
—
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
—
—
Other
Enumeration date
07/18/2018
Last updated
07/18/2018
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