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General NPI Number Information
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NPI Number | 1356507495
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Entity Type | Organization
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Legal Business Name | GUTTENBERG DENTAL CARE PC
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Dates
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Enumeration Date | 07/29/2008
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Last Update Date | 07/29/2008
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Provider Practice Location Address
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Address Line | 6915 PARK AVE
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City | GUTTENBERG
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State | NJ
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Zip | 07093
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Country | US
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Telephone | 201-868-0808
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Fax | 201-868-0898
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Provider Business Mailing Address
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Address Line | 6915 PARK AVE
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City | GUTTENBERG
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State | NJ
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Zip | 07093
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Country | US
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Telephone | 201-868-0808
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Fax | 201-868-0898
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Authorized Official
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Title or Position | OWNER DENTIST
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Name | DAVID LAC
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Credential | DDS
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Telephone | 201-868-0808
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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 | 20288
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License Number State | NJ
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