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General NPI Number Information
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NPI Number | 1003059965
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Entity Type | Organization
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Legal Business Name | ROCKAWAY FAMILY DENTAL LLC.
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Dates
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Enumeration Date | 04/08/2009
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Last Update Date | 04/08/2009
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Provider Practice Location Address
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Address Line | 200 E MAIN ST STE A&B
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City | ROCKAWAY
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State | NJ
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Zip | 07866-3614
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Country | US
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Telephone | 973-784-4749
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Fax | 973-784-4537
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Provider Business Mailing Address
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Address Line | 200 E MAIN ST STE A&B
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City | ROCKAWAY
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State | NJ
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Zip | 07866-3614
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Country | US
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Telephone | 973-784-4749
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Fax | 973-784-4537
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Authorized Official
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Title or Position | OWNER
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Name | DR. WEIMIN JIN
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Credential |
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Telephone | 973-784-4749
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 22DI02289200
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 22DI02217100
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License Number State | NJ
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