Healthcare Provider Details

I. General information

NPI: 1467621490
Provider Name (Legal Business Name): EASTERN DENTAL OF FLEMINGTON, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/25/2008
Last Update Date: 02/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

433 US HIGHWAY 202
FLEMINGTON NJ
08822-6041
US

IV. Provider business mailing address

1030 SAINT GEORGES AVE
AVENEL NJ
07001-1390
US

V. Phone/Fax

Practice location:
  • Phone: 908-237-2100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number20509
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number10967
License Number StateNJ

VIII. Authorized Official

Name: DR. AARON FEILER
Title or Position: EXECUTIVE DENTAL DIRECTOR
Credential: D.D.S
Phone: 908-237-2100