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General NPI Number Information
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NPI Number | 1609949296
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Entity Type | Organization
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Legal Business Name | MITCHELL H. DAVICH, DMD, PA
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Dates
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Enumeration Date | 11/15/2006
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Last Update Date | 08/05/2008
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Provider Practice Location Address
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Address Line | 95 MADISON AVE SUITE A02
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City | MORRISTOWN
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State | NJ
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Zip | 07960-6092
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Country | US
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Telephone | 973-898-0100
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Fax |
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Provider Business Mailing Address
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Address Line | 95 MADISON AVE SUITE A02
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City | MORRISTOWN
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State | NJ
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Zip | 07960-6092
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Country | US
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Telephone | 973-898-0100
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Fax |
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Authorized Official
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Title or Position | BUSINESS MANAGER
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Name | MRS. BARBARA L. DAVICH
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Credential |
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Telephone | 973-898-0100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | 22DI01228100
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License Number State | NJ
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