| NPI | 1972609451 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VIRGINIA WICKE Office Manager 908-688-0022 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery |
| Additional Taxonomies | 1223G0001X Dentist, General Practice |
| 1223P0300X Dentist, Periodontics | |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics | |
| 124Q00000X Dental Hygienist | |
| Enumeration Date | 2006-09-15 |
| Last Update Date | 2025-09-11 |