Healthcare Provider Details

I. General information

NPI: 1235285461
Provider Name (Legal Business Name): WESTFIELD ORTHODONTIC ASSOCIATES PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

531 EAST BROAD STREET
WESTFIELD NJ
07090
US

IV. Provider business mailing address

531 EAST BROAD STREET
WESTFIELD NJ
07090
US

V. Phone/Fax

Practice location:
  • Phone: 908-232-1027
  • Fax: 908-232-5221
Mailing address:
  • Phone: 908-232-1027
  • Fax: 908-232-5221

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number22DI00917300
License Number StateNJ

VIII. Authorized Official

Name: DR. JAMES JOSEPH PETERSON
Title or Position: PRESIDENT
Credential: DDS MSD
Phone: 908-232-1027