| NPI | 1366988842 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRIAN VAN SLOOTEN Owner 201-819-8562 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: VA 0401414418) |
| Enumeration Date | 2017-01-09 |
| Last Update Date | 2017-01-09 |