Healthcare Provider Details

I. General information

NPI: 1366875528
Provider Name (Legal Business Name): DENTAL GROUP OF EAST BRUNSWICK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2013
Last Update Date: 08/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

385 CRANBURY RD
EAST BRUNSWICK NJ
08816-3000
US

IV. Provider business mailing address

385 CRANBURY RD
EAST BRUNSWICK NJ
08816-3000
US

V. Phone/Fax

Practice location:
  • Phone: 732-254-0033
  • Fax: 732-238-8869
Mailing address:
  • Phone: 732-254-0033
  • Fax: 732-238-8869

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number22DI2208200
License Number StateNJ

VIII. Authorized Official

Name: NAHEL YANNI
Title or Position: DENTIST
Credential: D.D.S
Phone: 732-254-0033