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General NPI Number Information
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NPI Number | 1376797068
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Entity Type | Organization
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Legal Business Name | MONTGOMERY GREENE DENTAL
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Dates
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Enumeration Date | 11/08/2008
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Last Update Date | 11/08/2008
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Provider Practice Location Address
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Address Line | 105 GREENE ST SUITE 1B
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City | JERSEY CITY
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State | NJ
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Zip | 07302-3848
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Country | US
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Telephone | 201-204-0737
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Fax |
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Provider Business Mailing Address
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Address Line | 105 GREENE ST SUITE 1B
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City | JERSEY CITY
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State | NJ
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Zip | 07302-3848
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Country | US
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Telephone | 201-204-0737
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. LANA BUNIS
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Credential | DDS
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Telephone | 201-204-0737
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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 | 22DI02203700
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 22DI02264800
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License Number State | NJ
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