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General NPI Number Information
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NPI Number | 1134164312
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Entity Type | Organization
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Legal Business Name | PRINCETON ENDODONTICS
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Dates
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Enumeration Date | 06/19/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 601 EWING ST SUITE A-10
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City | PRINCETON
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State | NJ
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Zip | 08540-2757
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Country | US
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Telephone | 609-497-1188
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Fax |
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Provider Business Mailing Address
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Address Line | 26 BLUE HERON WAY
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City | SKILLMAN
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State | NJ
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Zip | 08558-2248
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Country | US
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Telephone | 609-333-1340
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | STEPHEN M LEVESON
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Credential | DMD
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Telephone | 609-497-1188
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | DI16655
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License Number State | NJ
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