| NPI | 1457787087 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JORGE A BASTIDAS Owner 973-742-2610 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center Dental (Licence: NJ DI017854000) |
| Enumeration Date | 2013-09-14 |
| Last Update Date | 2013-09-14 |