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General NPI Number Information
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NPI Number | 1730527961
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Entity Type | Organization
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Legal Business Name | FANWOOD DENTAL ASSOCIATES, INC.
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Dates
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Enumeration Date | 06/10/2013
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Last Update Date | 06/10/2013
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Provider Practice Location Address
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Address Line | 225 N MARTINE AVE
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City | FANWOOD
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State | NJ
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Zip | 07023-1336
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Country | US
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Telephone | 732-266-2911
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Fax |
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Provider Business Mailing Address
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Address Line | 85 DELLWOOD RD
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City | EDISON
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State | NJ
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Zip | 08820-3865
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Country | US
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Telephone | 732-266-2911
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | NIMA M. PATEL
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Credential | DMD
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Telephone | 732-266-2911
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 22DI02245600
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License Number State | NJ
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