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General NPI Number Information
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NPI Number | 1205566114
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Entity Type | Organization
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Legal Business Name | 380 DENTAL CARE GROUP LLC
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Dates
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Enumeration Date | 06/14/2022
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Last Update Date | 06/14/2022
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Provider Practice Location Address
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Address Line | 380 FAIRFIELD RD
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City | FAIRFIELD
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State | NJ
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Zip | 07004-1934
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Country | US
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Telephone | 973-402-0595
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Fax | 973-808-1177
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Provider Business Mailing Address
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Address Line | 380 FAIRFIELD RD
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City | FAIRFIELD
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State | NJ
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Zip | 07004-1934
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Country | US
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Telephone | 973-402-0595
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Fax | 973-808-1177
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Authorized Official
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Title or Position | OWNER
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Name | DR. DEREK LAU
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Credential | DMD
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Telephone | 973-402-0595
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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 |
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License Number State |
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