| NPI | 1740493337 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JASON GOLDBERG Director 732-660-0500 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: NJ 21630) |
| Additional Taxonomies | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: NJ 10967) |
| Enumeration Date | 2007-05-08 |
| Last Update Date | 2020-08-22 |