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General NPI Number Information
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NPI Number | 1063561025
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Entity Type | Organization
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Legal Business Name | ROBERT WOOD JOHNSON UNIVERSITY HOSPITAL DENTAL SUITE
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Dates
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Enumeration Date | 01/09/2007
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Last Update Date | 12/15/2011
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Provider Practice Location Address
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Address Line | 1 ROBERT WOOD JOHNSON PL DENTAL SUITE
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City | NEW BRUNSWICK
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State | NJ
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Zip | 08901-1928
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Country | US
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Telephone | 732-937-8653
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Fax | 732-253-3575
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Provider Business Mailing Address
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Address Line | 1 ROBERT WOOD JOHNSON PL DENTAL SUITE
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City | NEW BRUNSWICK
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State | NJ
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Zip | 08901-1928
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Country | US
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Telephone | 732-937-8653
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Fax | 732-253-3575
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Authorized Official
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Title or Position | DIRECTOR, DENTAL SUITE
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Name | MS. JACQUELINE S. REID
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Credential | DDS
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Telephone | 732-937-8653
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | DI019921
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License Number State | NJ
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