Healthcare Provider Details

I. General information

NPI: 1457597056
Provider Name (Legal Business Name): INFINITE ENDODONTICS NORTH JERSEY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/02/2009
Last Update Date: 01/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

485 US ROUTE 1 & PLAINFIELD AVENUE
EDISON NJ
08117
US

IV. Provider business mailing address

401 COMMERCE DRIVE SUITE 108
FORT WASHINGTON PA
19034
US

V. Phone/Fax

Practice location:
  • Phone: 732-985-4350
  • Fax: 732-819-7669
Mailing address:
  • Phone: 215-646-6188
  • Fax: 215-646-6369

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number22DI02071600
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: SPENCER SAINT CYR
Title or Position: OWNER
Credential: DMD
Phone: 732-985-4350