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General NPI Number Information
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NPI Number | 1508058942
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Entity Type | Organization
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Legal Business Name | RED BANK DENTAL ASSOCIATES
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Dates
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Enumeration Date | 08/09/2007
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Last Update Date | 08/09/2007
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Provider Practice Location Address
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Address Line | 258 BROAD ST
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City | RED BANK
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State | NJ
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Zip | 07701-2035
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Country | US
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Telephone | 732-747-2597
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Fax | 732-747-8688
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Provider Business Mailing Address
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Address Line | 258 BROAD ST
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City | RED BANK
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State | NJ
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Zip | 07701-2035
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Country | US
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Telephone | 732-747-2597
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Fax | 732-747-8688
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Authorized Official
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Title or Position | OWNER/PARTNER
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Name | DR. THOMAS J DRISCOLL
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Credential | DDS
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Telephone | 732-747-2597
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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 | 13299/18409
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License Number State | NJ
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