| NPI | 1376617902 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BARRY DAVID WAGENBERG President 973-994-9995 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: NJ DI10755) |
| Enumeration Date | 2006-11-17 |
| Last Update Date | 2020-08-22 |