| NPI | 1912734286 |
|---|---|
| Doing Business As | DESTINY DENTAL OF MACK |
| Entity Type | Organization |
| Authorized Contact | SIMONE WILSON-ADELEKE Director Of Credentialing 732-731-8398 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Enumeration Date | 2024-09-19 |
| Last Update Date | 2024-09-19 |