| NPI | 1891085569 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MELINDA L. WAGNER Owner 732-747-2022 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NJ 14142) |
| Enumeration Date | 2011-04-14 |
| Last Update Date | 2011-04-14 |