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General NPI Number Information
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NPI Number | 1164747457
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Entity Type | Organization
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Legal Business Name | ADVANCED DENTAL
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Dates
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Enumeration Date | 03/30/2010
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Last Update Date | 03/30/2010
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Provider Practice Location Address
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Address Line | 735 MOUNT PROSPECT AVE
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City | NEWARK
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State | NJ
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Zip | 07104-3111
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Country | US
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Telephone | 973-485-8989
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Fax | 973-485-8909
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Provider Business Mailing Address
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Address Line | 735 MOUNT PROSPECT AVE
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City | NEWARK
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State | NJ
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Zip | 07104-3111
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Country | US
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Telephone | 973-485-8989
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Fax | 973-485-8909
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Authorized Official
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Title or Position | PARTNER
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Name | DR. MIGUEL B. POU
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Credential | DDS
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Telephone | 973-485-8989
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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 |
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License Number State |
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