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General NPI Number Information
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NPI Number | 1154682862
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Entity Type | Organization
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Legal Business Name | SEYMOUR M GROSS DDS DAVID A MALOFF DMD PA
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Dates
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Enumeration Date | 05/30/2012
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Last Update Date | 05/30/2012
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Provider Practice Location Address
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Address Line | 2170 MORRIS AVE
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City | UNION
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State | NJ
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Zip | 07083
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Country | US
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Telephone | 908-686-7190
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Fax | 908-686-7192
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Provider Business Mailing Address
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Address Line | 2170 MORRIS AVE
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City | UNION
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State | NJ
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Zip | 07083
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Country | US
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Telephone | 908-686-7190
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Fax | 908-686-7192
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Authorized Official
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Title or Position | DENTIST
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Name | DR. DAVID ALAN MALOFF
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Credential |
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Telephone | 908-686-7190
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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 | 09529
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License Number State | NJ
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