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General NPI Number Information
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NPI Number | 1477006492
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Entity Type | Organization
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Legal Business Name | DEGEORGE DENTAL LLC
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Dates
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Enumeration Date | 07/26/2016
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Last Update Date | 07/26/2016
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Provider Practice Location Address
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Address Line | 53 PAYNE RD
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City | LEBANON
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State | NJ
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Zip | 08833
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Country | US
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Telephone | 908-735-7888
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Fax | 908-735-7976
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Provider Business Mailing Address
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Address Line | 53 PAYNE RD
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City | LEBANON
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State | NJ
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Zip | 08833
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Country | US
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Telephone | 908-735-7888
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Fax | 908-735-7976
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Authorized Official
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Title or Position | OWNER
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Name | CAROL DEGEORGE
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Credential | DMD
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Telephone | 908-735-7888
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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