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General NPI Number Information
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NPI Number | 1598037996
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Entity Type | Organization
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Legal Business Name | STRONG ROOTS DENTAL PC
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Dates
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Enumeration Date | 01/31/2012
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Last Update Date | 02/28/2019
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Provider Practice Location Address
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Address Line | 273 NEWARK AVENUE
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City | JERSEY CITH
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State | NJ
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Zip | 07302
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Country | US
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Telephone | 551-200-6002
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Fax | 201-984-0607
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Provider Business Mailing Address
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Address Line | 273 NEWARK AVENUE
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City | JERSEY CITH
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State | NJ
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Zip | 07302
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Country | US
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Telephone | 551-200-6002
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Fax | 201-984-0607
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. JAHAYRA JUAREZ
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Credential |
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Telephone | 551-200-6002
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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 | 22DIO2449200
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 22DI02410701
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License Number State | NJ
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