| NPI | 1164282570 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK KOGAN Chief Clinical Officer 201-406-6596 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics | |
| Enumeration Date | 2024-03-21 |
| Last Update Date | 2024-03-21 |