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General NPI Number Information
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NPI Number | 1366875528
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Entity Type | Organization
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Legal Business Name | DENTAL GROUP OF EAST BRUNSWICK
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Dates
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Enumeration Date | 08/12/2013
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Last Update Date | 08/12/2013
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Provider Practice Location Address
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Address Line | 385 CRANBURY RD
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City | EAST BRUNSWICK
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State | NJ
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Zip | 08816-3000
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Country | US
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Telephone | 732-254-0033
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Fax | 732-238-8869
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Provider Business Mailing Address
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Address Line | 385 CRANBURY RD
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City | EAST BRUNSWICK
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State | NJ
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Zip | 08816-3000
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Country | US
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Telephone | 732-254-0033
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Fax | 732-238-8869
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Authorized Official
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Title or Position | DENTIST
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Name | NAHEL YANNI
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Credential | D.D.S
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Telephone | 732-254-0033
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 22DI2208200
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License Number State | NJ
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