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General NPI Number Information
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NPI Number | 1396096855
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Entity Type | Organization
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Legal Business Name | KELNER PERIODONTICS
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Dates
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Enumeration Date | 09/25/2012
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Last Update Date | 09/25/2012
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Provider Practice Location Address
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Address Line | 1119 RARITAN RD
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City | CLARK
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State | NJ
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Zip | 07066
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Country | US
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Telephone | 908-753-4427
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Fax | 908-756-7019
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Provider Business Mailing Address
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Address Line | 1119 RARITAN RD
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City | CLARK
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State | NJ
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Zip | 07066
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Country | US
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Telephone | 732-382-9090
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Fax | 732-396-1527
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Authorized Official
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Title or Position | OWNER
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Name | DANIELLE B. KELNER
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Credential | D.M.D
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Telephone | 732-382-9090
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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 | 22D102321200
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License Number State | NJ
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