| NPI | 1487398285 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SAM WISE Owner 973-747-6425 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X2210X Dentist, Orofacial Pain |
| Additional Taxonomies | 261QD0000X Clinic/Center, Dental |
| 261QR0200X Clinic/Center, Radiology | |
| 261QS0112X Clinic/Center, Oral and Maxillofacial Surgery | |
| 261QS1200X Clinic/Center, Sleep Disorder Diagnostic | |
| 292200000X Dental Laboratory | |
| Enumeration Date | 2022-04-27 |
| Last Update Date | 2022-04-27 |