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General NPI Number Information
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NPI Number | 1649300500
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Entity Type | Organization
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Legal Business Name | STELTON DENTAL CENTER
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Dates
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Enumeration Date | 03/07/2007
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Last Update Date | 09/06/2011
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Provider Practice Location Address
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Address Line | 1100 STELTON RD
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City | PISCATAWAY
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State | NJ
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Zip | 08854-5202
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Country | US
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Telephone | 732-777-0660
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Fax | 732-777-0609
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Provider Business Mailing Address
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Address Line | 1100 STELTON RD
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City | PISCATAWAY
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State | NJ
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Zip | 08854-5202
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Country | US
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Telephone | 732-777-0660
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Fax | 732-777-0609
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Authorized Official
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Title or Position | DENTIST
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Name | DR. JASON C CHANG
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Credential | D.M.D.M.S.
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Telephone | 732-777-0660
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 22DI02039500
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License Number State | NJ
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