| NPI | 1306964226 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | FREDERICK R VAN ISTENDAL President 856-983-0060 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: NJ 22DI00903200) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: NJ 22DI01834400) |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: NJ 22DI01122502) | |
| Enumeration Date | 2007-03-27 |
| Last Update Date | 2020-08-22 |