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General NPI Number Information
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NPI Number | 1831369016
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Entity Type | Organization
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Legal Business Name | ROXBURY/HACKETTSTOWN DENTAL
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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 | 73 SUNSET STRIP
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City | SUCCASUNNA
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State | NJ
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Zip | 07876-1311
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Country | US
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Telephone | 973-584-8224
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Fax | 973-584-5414
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Provider Business Mailing Address
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Address Line | 73 SUNSET STRIP
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City | SUCCASUNNA
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State | NJ
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Zip | 07876-1311
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Country | US
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Telephone | 973-584-8224
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Fax | 973-584-5414
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. SIMON B LEVENTHAL
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Credential | DDS
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Telephone | 973-584-8224
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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 | 22DI00756300
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License Number State | NJ
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