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General NPI Number Information
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NPI Number | 1174740567
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Entity Type | Organization
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Legal Business Name | LIVINGSTON ENDODONTIC ASSOCIATES, P.A.
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Dates
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Enumeration Date | 04/19/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 201 S LIVINGSTON AVE SUITE 2B
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City | LIVINGSTON
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State | NJ
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Zip | 07039-4043
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Country | US
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Telephone | 973-994-1661
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Fax | 973-740-8899
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Provider Business Mailing Address
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Address Line | 201 S LIVINGSTON AVE SUITE 2B
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City | LIVINGSTON
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State | NJ
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Zip | 07039-4043
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Country | US
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Telephone | 973-994-1661
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Fax | 973-740-8899
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MARC BALSON
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Credential | D.D.S.
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Telephone | 973-994-1661
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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 | 22DI01293000
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License Number State | NJ
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