| NPI | 1215626528 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SIMONE WILSON Director Of Credentialing 732-731-8398 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice |
| Additional Taxonomies | 122300000X Dentist |
| Enumeration Date | 2023-05-02 |
| Last Update Date | 2024-09-06 |