| NPI | 1174986822 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JUSTIN CHARLES PONQUINETTE Owner 732-747-0993 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QS0112X Clinic/Center, Oral and Maxillofacial Surgery (Licence: NJ 0400696228) |
| Enumeration Date | 2016-03-31 |
| Last Update Date | 2016-03-31 |