Healthcare Provider Details

I. General information

NPI: 1982928313
Provider Name (Legal Business Name): LOUIS C GUBITOSA AND VINCENT M FREY DMD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2010
Last Update Date: 03/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28 JACKSON AVE
POMPTON PLAINS NJ
07444-1479
US

IV. Provider business mailing address

28 JACKSON AVE
POMPTON PLAINS NJ
07444-1479
US

V. Phone/Fax

Practice location:
  • Phone: 973-831-0382
  • Fax:
Mailing address:
  • Phone: 973-831-0382
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. VINCENT M FREY
Title or Position: PARTNER
Credential: DMD
Phone: 973-831-0382