| NPI | 1053745117 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JESSICA L WOLLENBERG Sole Mbr 973-945-9309 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0106X Dentist, Oral and Maxillofacial Pathology (Licence: NJ 22DI02546000) |
| Enumeration Date | 2013-08-26 |
| Last Update Date | 2014-01-07 |