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General NPI Number Information
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NPI Number | 1063628550
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Entity Type | Organization
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Legal Business Name | WAYNE DENTAL ARTS, LLC
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Dates
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Enumeration Date | 05/14/2007
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Last Update Date | 09/07/2008
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Provider Practice Location Address
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Address Line | 601 HAMBURG TPKE SUITE 206
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City | WAYNE
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State | NJ
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Zip | 07470-2048
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Country | US
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Telephone | 973-956-7772
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Fax | 973-956-8788
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Provider Business Mailing Address
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Address Line | 601 HAMBURG TPKE SUITE 206
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City | WAYNE
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State | NJ
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Zip | 07470-2048
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Country | US
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Telephone | 973-956-7772
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Fax | 973-956-8788
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Authorized Official
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Title or Position | OWNER
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Name | DR. ROSS LESSER
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Credential | DMD
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Telephone | 973-956-7772
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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 | DI17675
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License Number State | NJ
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