| NPI | 1053585612 |
|---|---|
| Former Legal Business Name | BROOKSIDE FAMILY DENTAL |
| Entity Type | Organization |
| Authorized Contact | KINDA HANNA YACOUB Dds 973-566-6161 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NJ D1020914) |
| Enumeration Date | 2008-04-15 |
| Last Update Date | 2008-04-15 |