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General NPI Number Information
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NPI Number | 1467294819
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Entity Type | Organization
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Legal Business Name | CENTER FOR DENTISTRY OF VERNON LLC
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Dates
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Enumeration Date | 06/07/2024
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Last Update Date | 06/07/2024
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Provider Practice Location Address
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Address Line | 5 ROUTE 94 UNIT GH
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City | VERNON
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State | NJ
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Zip | 07462-3553
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Country | US
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Telephone | 973-827-0234
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Fax | 973-826-1105
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Provider Business Mailing Address
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Address Line | 5 ROUTE 94 UNIT GH
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City | VERNON
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State | NJ
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Zip | 07462-3553
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Country | US
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Telephone | 973-827-0234
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Fax | 973-826-1105
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Authorized Official
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Title or Position | OWNER - GENERAL DENTIST
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Name | DR. BRIAN MARINO
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Credential | DMD
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Telephone | 973-827-0234
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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