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General NPI Number Information
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NPI Number | 1174358212
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Entity Type | Organization
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Legal Business Name | L&M DENTAL GROUP LLC
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Dates
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Enumeration Date | 09/06/2024
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Last Update Date | 09/06/2024
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Provider Practice Location Address
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Address Line | 255 MAIN ST
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City | RIDGEFIELD PARK
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State | NJ
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Zip | 07660-1598
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Country | US
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Telephone | 201-440-0434
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Fax |
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Provider Business Mailing Address
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Address Line | 5 GOBLE TER
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City | MIDLAND PARK
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State | NJ
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Zip | 07432-1628
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DENTIST/OWNER
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Name | DR. MICHAEL DAVID COLARUSSO
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Credential | DDS
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Telephone | 201-803-8526
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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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