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General NPI Number Information
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NPI Number | 1376668723
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Entity Type | Organization
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Legal Business Name | GENERAL DENTISTRY ASSOCIATES OF FREEHOLD, P.A.
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Dates
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Enumeration Date | 03/21/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 84 W MAIN ST
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City | FREEHOLD
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State | NJ
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Zip | 07728-2134
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Country | US
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Telephone | 732-462-1631
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Fax |
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Provider Business Mailing Address
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Address Line | 84 W MAIN ST
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City | FREEHOLD
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State | NJ
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Zip | 07728-2134
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Country | US
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Telephone | 732-462-1631
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. NELSON A WOLLEK
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Credential | D.D.S.
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Telephone | 732-462-1631
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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 | NJDI017443
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License Number State | NJ
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