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General NPI Number Information
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NPI Number | 1649476649
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Entity Type | Organization
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Legal Business Name | GARY S. CRYSTAL, DMD,PA
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Dates
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Enumeration Date | 06/26/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 221 SHERMAN AVE
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City | BERKELEY HEIGHTS
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State | NJ
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Zip | 07922-1173
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Country | US
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Telephone | 908-665-0200
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Fax | 908-771-0156
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Provider Business Mailing Address
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Address Line | 221 SHERMAN AVE
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City | BERKELEY HEIGHTS
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State | NJ
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Zip | 07922-1173
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Country | US
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Telephone | 908-665-0200
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Fax | 908-771-0156
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. GARY CRYSTAL
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Credential | DMD
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Telephone | 908-665-0200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0700X
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Taxonomy Name | Prosthodontics
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License Number | 18639
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License Number State | NJ
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