Healthcare Provider Details

I. General information

NPI: 1922506831
Provider Name (Legal Business Name): SOUTH BOUND BROOK DENTAL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2018
Last Update Date: 01/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 MAIN ST
SOUTH BOUND BROOK NJ
08880-1501
US

IV. Provider business mailing address

120 MAIN ST
SOUTH BOUND BROOK NJ
08880-1501
US

V. Phone/Fax

Practice location:
  • Phone: 732-829-4298
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. JAMES OCCHIPINTI
Title or Position: OWNER
Credential: DMD
Phone: 732-829-4298