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General NPI Number Information
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NPI Number | 1528282662
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Entity Type | Organization
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Legal Business Name | AMERICAN DENTAL CENTER OF EATONTOWN
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Dates
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Enumeration Date | 04/12/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 67 STATE ROUTE 36
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City | WEST LONG BRANCH
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State | NJ
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Zip | 07764-1432
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Country | US
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Telephone | 732-571-8844
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Fax | 732-571-8800
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Provider Business Mailing Address
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Address Line | 67 STATE ROUTE 36
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City | WEST LONG BRANCH
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State | NJ
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Zip | 07764-1432
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Country | US
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Telephone | 732-571-8844
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Fax | 732-571-8800
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Authorized Official
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Title or Position | OWNER
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Name | GILBERT GLASS
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Credential | D.M.D.
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Telephone | 732-571-8844
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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 | 22DI01000400
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License Number State | NJ
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