MEDICARE: POMPTON DENTAL ARTS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1659536175
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	POMPTON DENTAL ARTS LLC

Provider Business Mailing Address
First Line	:	435 RINGWOOD AVE
Second Line	:
City	:	POMPTON LAKES
State	:	NJ
Zip	:	07442-2208
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	435 RINGWOOD AVE
Second Line	:
City	:	POMPTON LAKES
State	:	NJ
Zip	:	07442-2208
Country	:	US
Telephone Number	:	973-835-0702
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. RYAN ZLOTKOWSKI
Credential	:
Telephone Number	:	973-835-0702

Provider Enumeration Date	:	07/24/2008
Last Update Date	:	07/24/2008

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