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General NPI Number Information
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NPI Number | 1093874760
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Entity Type | Organization
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Legal Business Name | DNA DENTAL
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Dates
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Enumeration Date | 12/08/2006
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Last Update Date | 07/02/2010
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Provider Practice Location Address
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Address Line | 349 EAST NORTHFIELD RD SUITE #207
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City | LIVINGSTON
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State | NJ
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Zip | 07039
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Country | US
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Telephone | 973-535-4300
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Fax | 973-535-4308
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Provider Business Mailing Address
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Address Line | 349 E. NORTHFIELD RD SUITE #207
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City | LIVINGSTON
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State | NJ
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Zip | 07039
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Country | US
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Telephone | 973-535-4300
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Fax | 973-535-4308
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. KEYANNA T INGRAU
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Credential |
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Telephone | 973-535-4300
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 126800000X
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Taxonomy Name | Dental Assistant
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License Number | 22D101996200
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License Number State | NJ
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