| NPI | 1417492893 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VIRGIL JASON VIVES Owner 732-727-6666 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: NJ 22D102246000) |
| Enumeration Date | 2016-12-21 |
| Last Update Date | 2016-12-21 |