| NPI | 1508924754 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CORY A WANATICK President 201-461-4133 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: NJ DI018012) |
| Enumeration Date | 2006-12-04 |
| Last Update Date | 2020-08-22 |