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General NPI Number Information
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NPI Number | 1629500715
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Entity Type | Organization
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Legal Business Name | ROXBURY PEDIATRIC DENTISTRY
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Dates
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Enumeration Date | 03/29/2017
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Last Update Date | 03/29/2017
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Provider Practice Location Address
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Address Line | 168 ROUTE 10 W
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City | SUCCASUNNA
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State | NJ
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Zip | 07876-1434
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Country | US
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Telephone | 973-584-7555
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Fax |
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Provider Business Mailing Address
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Address Line | 168 ROUTE 10 W
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City | SUCCASUNNA
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State | NJ
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Zip | 07876-1434
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Country | US
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Telephone | 973-584-7555
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Fax |
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Authorized Official
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Title or Position | LICENSING COORDINATOR
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Name | MS. KIMBERLY ANN MAHER
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Credential |
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Telephone | 973-598-9555
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 22DI02441400
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License Number State | NJ
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