| NPI | 1093874760 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KEYANNA T INGRAU Office Manager 973-535-4300 |
| Organization Subpart ? | No |
| Primary Taxonomy | 126800000X Dental Assistant (Licence: NJ 22D101996200) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice |
| 1223P0300X Dentist, Periodontics | |
| Enumeration Date | 2006-12-08 |
| Last Update Date | 2010-07-02 |