| NPI | 1235844929 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHELLE BUNTZEN Regional Operations 201-694-5290 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Additional Taxonomies | 1223D0004X Dentist, Dentist Anesthesiologist Speciality |
| Enumeration Date | 2023-01-18 |
| Last Update Date | 2023-01-18 |