Healthcare Provider Details

I. General information

NPI: 1750774238
Provider Name (Legal Business Name): QDC OF BRIDGETON LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2015
Last Update Date: 03/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1117 HIGHWAY 77 SUITE A
BRIDGETON NJ
08302-3650
US

IV. Provider business mailing address

1030 SAINT GEORGES AVE
AVENEL NJ
07001-1390
US

V. Phone/Fax

Practice location:
  • Phone: 732-750-0707
  • Fax:
Mailing address:
  • Phone: 732-750-0707
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number StateNJ

VIII. Authorized Official

Name: DR. AARON FEILER
Title or Position: OWNER
Credential: DDS
Phone: 732-750-0707