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General NPI Number Information
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NPI Number | 1750551933
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Entity Type | Organization
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Legal Business Name | ADMIRALTY DENTAL ASSOCIATES, P.A.
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Dates
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Enumeration Date | 03/04/2008
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Last Update Date | 03/04/2008
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Provider Practice Location Address
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Address Line | 1033 RIVER RD UNIT #4
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City | EDGEWATER
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State | NJ
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Zip | 07020-1351
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Country | US
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Telephone | 201-224-0900
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Fax | 201-943-4574
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Provider Business Mailing Address
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Address Line | 1033 RIVER RD UNIT #4
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City | EDGEWATER
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State | NJ
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Zip | 07020-1351
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Country | US
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Telephone | 201-224-0900
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Fax | 201-943-4574
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. KENNETH L GOLDBERG
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Credential | D.M.D.
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Telephone | 201-224-0900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 09850
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License Number State | NJ
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