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Pediatric Dentistry

Bayonne, New Jersey

Provider NPI: 1841341252

Provider Information:
Gender: M
Sole Proprietor

Practice Location:
Tel: 201-858-3800  Fax: 201-858-4409

Business Mailing Address:
Tel: 201-858-3800  Fax: 201-858-4409

Entity Type: Individual


PrimaryCodeCategory/DescriptionStateLicense Number
Y1223P0221XDental Providers
Pediatric Dentistry

Other Provider Identifiers:

Code values:
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin


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