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General NPI Number Information
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NPI Number | 1477445799
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Entity Type | Organization
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Legal Business Name | MONTVILLE DENTAL STUDIO LLC
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Dates
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Enumeration Date | 07/21/2025
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Last Update Date | 07/21/2025
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Provider Practice Location Address
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Address Line | 170 CHANGEBRIDGE ROAD SUITE A2
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City | MONTVILLE
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State | NJ
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Zip | 07045
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Country | US
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Telephone | 973-575-6100
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Fax |
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Provider Business Mailing Address
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Address Line | 53 HOLLY COURT
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City | EDISON
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State | NJ
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Zip | 08820
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Country | US
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Telephone | 818-267-4660
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Fax |
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Authorized Official
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Title or Position | MEMBER/OWNER
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Name | BINITA SHAH
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Credential | D.D.S
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Telephone | 818-267-4660
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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 |
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License Number State |
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