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General NPI Number Information
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NPI Number | 1316202963
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Entity Type | Organization
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Legal Business Name | ROCKAWAY ORTHODONTICS, PA
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Dates
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Enumeration Date | 07/10/2012
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Last Update Date | 07/10/2012
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Provider Practice Location Address
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Address Line | 141 US HIGHWAY 46 SUITE 101
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City | ROCKAWAY
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State | NJ
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Zip | 07866-4018
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Country | US
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Telephone | 973-627-2229
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Fax | 973-627-2291
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Provider Business Mailing Address
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Address Line | 141 US HIGHWAY 46 SUITE 101
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City | ROCKAWAY
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State | NJ
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Zip | 07866-4018
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Country | US
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Telephone | 973-627-2229
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Fax | 973-627-2291
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Authorized Official
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Title or Position | OWNER
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Name | DR. MELISSA J GRIEDER-ROBERTO
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Credential | DMD
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Telephone | 973-627-2229
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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 | 22DI02197300
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License Number State | NJ
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