| NPI | 1669209938 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SIMONE WILSON-ADELEKE Director Of Credentialing 732-731-8398 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist |
| Additional Taxonomies | 1223G0001X Dentist General Practice |
| Enumeration Date | 2024-09-19 |
| Last Update Date | 2024-09-19 |