| NPI | 1831618529 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GREGG A JACOB Owner 973-360-1100 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NJ 22DI02252800) |
| Enumeration Date | 2017-09-13 |
| Last Update Date | 2022-07-21 |