| NPI | 1073915369 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL KEITH GOULSTON Owner 908-222-0040 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QS0112X Clinic/Center, Oral and Maxillofacial Surgery (Licence: NJ 22DI02509200) |
| Enumeration Date | 2014-09-18 |
| Last Update Date | 2015-01-09 |