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General NPI Number Information
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NPI Number | 1740968494
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Entity Type | Organization
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Legal Business Name | M&A DENTAL LLC
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Dates
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Enumeration Date | 07/11/2023
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Last Update Date | 07/11/2023
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Provider Practice Location Address
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Address Line | 286 NJ-35 S
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City | EATONTOWN
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State | NJ
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Zip | 07724
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Country | US
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Telephone | 732-542-7770
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Fax |
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Provider Business Mailing Address
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Address Line | 241 WASHINGTON AVE
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City | PINE BEACH
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State | NJ
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Zip | 08741-1544
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Country | US
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Telephone | 732-341-6010
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Fax |
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Authorized Official
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Title or Position | CO-OWNER
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Name | MARIYA MEDLENOV
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Credential | DDS
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Telephone | 267-288-3355
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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 |
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License Number State |
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