=====================================================
General NPI Number Information
=====================================================
NPI Number | 1477221570
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | VERNON DENTAL ARTS, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/02/2021
-----------------------------------------------------
Last Update Date | 09/02/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 249 STATE RT 94
-----------------------------------------------------
City | VERNON
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07462-3327
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-827-3400
-----------------------------------------------------
Fax | 973-827-3364
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 25 MAIN ST
-----------------------------------------------------
City | SPARTA
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07871-1937
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-729-5242
-----------------------------------------------------
Fax | 973-729-5914
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE MANAGER
-----------------------------------------------------
Name | MRS. CHRISTINE MULLER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 973-459-2121
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------