| NPI | 1174662712 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARIEL WOLCOTT Cred Coordinator 732-914-1039 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NJ 22DI017432) |
| Enumeration Date | 2007-02-06 |
| Last Update Date | 2020-08-22 |