| NPI | 1093113680 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TERESA ADDIEGO MOORE President/Owner 856-985-1800 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: NJ DI01771700) |
| Additional Taxonomies | 122300000X Dentist (Licence: NJ DI02582400) |
| 1223P0300X Dentist, Periodontics (Licence: NJ DI02514400) | |
| Enumeration Date | 2014-12-12 |
| Last Update Date | 2014-12-12 |