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General NPI Number Information
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NPI Number | 1710439666
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Entity Type | Organization
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Legal Business Name | DENTAL ARTS 4 TOTS 2 TEENS LLC
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Dates
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Enumeration Date | 10/26/2016
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Last Update Date | 10/26/2016
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Provider Practice Location Address
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Address Line | 3824 RIVER RD
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City | POINT PLEASANT BORO
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State | NJ
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Zip | 08742-2054
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Country | US
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Telephone | 732-202-7114
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Fax | 732-202-7191
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Provider Business Mailing Address
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Address Line | 3824 RIVER RD
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City | POINT PLEASANT BORO
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State | NJ
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Zip | 08742-2054
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Country | US
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Telephone | 732-202-7114
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Fax | 732-202-7191
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Authorized Official
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Title or Position | OWNER
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Name | DR. DIANE BALDWIN
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Credential | D.M.D
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Telephone | 732-202-7114
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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 | 220DI02349200
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License Number State | NJ
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