Healthcare Provider Details

I. General information

NPI: 1568485910
Provider Name (Legal Business Name): INNOVATIVE ENDODONTICS, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 VALLEY RD
WAYNE NJ
07470-3535
US

IV. Provider business mailing address

600 VALLEY RD
WAYNE NJ
07470-3535
US

V. Phone/Fax

Practice location:
  • Phone: 973-633-0097
  • Fax: 973-633-5029
Mailing address:
  • Phone: 973-633-0097
  • Fax: 973-633-5029

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number17695
License Number StateNJ

VII. Legacy identifiers

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

VIII. Authorized Official

Name: DR. LAWRENCE R LAW
Title or Position: PRESIDENT
Credential: D.M.D.
Phone: 973-633-0097