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General NPI Number Information
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NPI Number | 1043611684
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Entity Type | Organization
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Legal Business Name | SNORE FREE NJ, PC
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Dates
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Enumeration Date | 09/15/2014
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Last Update Date | 09/15/2014
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Provider Practice Location Address
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Address Line | 9 FURLER ST
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City | TOTOWA
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State | NJ
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Zip | 07512-1801
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Country | US
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Telephone | 973-975-7434
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Fax | 413-677-0904
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Provider Business Mailing Address
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Address Line | 41 WATCHUNG PLZ # 185
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City | MONTCLAIR
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State | NJ
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Zip | 07042-4117
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Country | US
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Telephone | 973-975-7434
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Fax | 413-677-0904
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Authorized Official
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Title or Position | PRESIDENT
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Name | JOAN VAN RAALTE
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Credential | DMD
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Telephone | 973-975-7434
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 22D101926300
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License Number State | NJ
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