Healthcare Provider Details

I. General information

NPI: 1609552009
Provider Name (Legal Business Name): WHITE OAK DENTAL NJ LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2023
Last Update Date: 06/22/2023
Certification Date: 06/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1040 US HIGHWAY 1 STE 103
AVENEL NJ
07001-1539
US

IV. Provider business mailing address

1040 US HIGHWAY 1 STE 103
AVENEL NJ
07001-1539
US

V. Phone/Fax

Practice location:
  • Phone: 732-582-4224
  • Fax: 732-582-4211
Mailing address:
  • Phone: 732-582-4224
  • Fax: 732-582-4211

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. ALVIN AQUINO
Title or Position: CEO
Credential: DMD
Phone: 732-582-4224