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General NPI Number Information
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NPI Number | 1043225451
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Entity Type | Organization
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Legal Business Name | MOUNTAIN LAKES DENTAL ASSOCIATES, PA
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Dates
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Enumeration Date | 07/31/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3125 STATE ROUTE 10 SUITE 1B
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City | DENVILLE
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State | NJ
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Zip | 07834-3493
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Country | US
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Telephone | 973-328-7199
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Fax | 973-328-7122
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Provider Business Mailing Address
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Address Line | 3125 STATE ROUTE 10 SUITE 1B
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City | DENVILLE
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State | NJ
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Zip | 07834-3493
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Country | US
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Telephone | 973-328-7199
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Fax | 973-328-7122
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. PETER KIN ENG
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Credential | D.M.D.
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Telephone | 973-328-7199
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 22DI01758000
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License Number State | NJ
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