| NPI | 1245499847 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | HERAWATI T KANDOU President Orthodontist 732-560-5988 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: NJ 9708) |
| Additional Taxonomies | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics (Licence: NJ 3026) |
| Enumeration Date | 2008-06-09 |
| Last Update Date | 2008-06-09 |