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General NPI Number Information
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NPI Number | 1598922692
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Entity Type | Organization
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Legal Business Name | WYCKOFF DENTAL ASSOCIATES, LLC
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Dates
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Enumeration Date | 05/18/2008
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Last Update Date | 05/18/2008
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Provider Practice Location Address
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Address Line | 615 WYCKOFF AVE
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City | WYCKOFF
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State | NJ
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Zip | 07481-1343
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Country | US
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Telephone | 201-891-0409
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Fax | 201-891-0803
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Provider Business Mailing Address
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Address Line | 615 WYCKOFF AVE
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City | WYCKOFF
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State | NJ
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Zip | 07481-1343
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Country | US
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Telephone | 201-891-0409
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Fax | 201-891-0803
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Authorized Official
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Title or Position | OWNER/PARTNER
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Name | DR. STEVEN ARTHUR MENILLO
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Credential | DDS
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Telephone | 201-891-0409
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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 | 14867
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License Number State | NJ
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