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General NPI Number Information
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NPI Number | 1790805281
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Entity Type | Organization
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Legal Business Name | MODERN DENTAL STUDIO, P.C.
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Dates
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Enumeration Date | 03/30/2007
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Last Update Date | 11/07/2023
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Provider Practice Location Address
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Address Line | 577 CRANBURY RD SUITE C-1
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City | EAST BRUNSWICK
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State | NJ
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Zip | 08816-5403
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Country | US
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Telephone | 732-432-0123
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Fax | 732-432-7979
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Provider Business Mailing Address
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Address Line | 577 CRANBURY RD SUITE C-1
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City | EAST BRUNSWICK
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State | NJ
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Zip | 08816-5403
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Country | US
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Telephone | 732-432-0123
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Fax | 732-432-7979
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. TRIPTHI SHETTY
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Credential | D.D.S.
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Telephone | 732-432-0123
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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