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General NPI Number Information
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NPI Number | 1497958664
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Entity Type | Individual
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Provider Name | MARTHA B MIQUEO D.D.S.
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Gender | Female
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Dates
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Enumeration Date | 06/06/2007
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Last Update Date | 11/03/2015
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Provider Practice Location Address
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Address Line | 300 SYLVAN AVE FL 3
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City | ENGLEWOOD CLIFFS
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State | NJ
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Zip | 07632-2525
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Country | US
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Telephone | 201-816-4000
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Fax | 201-816-1114
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Provider Business Mailing Address
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Address Line | 300 SYLVAN AVE FL 3
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City | ENGLEWOOD CLIFFS
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State | NJ
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Zip | 07632-2525
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Country | US
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Telephone | 201-816-4000
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Fax | 201-816-1114
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 22DI01791000
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 06134
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License Number State | NJ
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