| NPI | 1376204537 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANDREW ADLY Owner/Dentist 732-531-4165 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Additional Taxonomies | 261QD0000X Clinic/Center, Dental |
| 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment | |
| Enumeration Date | 2022-01-09 |
| Last Update Date | 2022-06-17 |