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General NPI Number Information
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NPI Number | 1194031609
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Entity Type | Organization
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Legal Business Name | MOUNTAIN VIEW ORTHODONTICS, LLC
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Dates
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Enumeration Date | 08/20/2010
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Last Update Date | 08/20/2010
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Provider Practice Location Address
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Address Line | 378 ROUTE 518 SUITE B
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City | SKILLMAN
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State | NJ
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Zip | 08558-2256
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Country | US
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Telephone | 609-466-5300
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Fax |
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Provider Business Mailing Address
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Address Line | 378 ROUTE 518 SUITE B
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City | SKILLMAN
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State | NJ
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Zip | 08558-2256
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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 | PRESIDENT
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Name | ANDREW WILBUR
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Credential | DMD
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Telephone | 609-466-5300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 22DI02187400
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License Number State | NJ
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