| NPI | 1043519416 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | OMAR T COCKEY CEO 973-779-6183 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center Dental (Licence: NJ DI 17684) |
| Additional Taxonomies | 261Q00000X Clinic/Center (Licence: NJ DI 17684) |
| Enumeration Date | 2011-03-24 |
| Last Update Date | 2011-03-24 |