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General NPI Number Information
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NPI Number | 1881874063
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Entity Type | Organization
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Legal Business Name | DERKASCH DENTAL HEALTH ASSOCIATES PA
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Dates
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Enumeration Date | 11/06/2007
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Last Update Date | 11/06/2007
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Provider Practice Location Address
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Address Line | 409 BOULEVARD
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City | KENILWORTH
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State | NJ
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Zip | 07033-1538
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Country | US
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Telephone | 908-276-2225
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Fax | 908-276-1550
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Provider Business Mailing Address
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Address Line | 409 BOULEVARD
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City | KENILWORTH
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State | NJ
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Zip | 07033-1538
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Country | US
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Telephone | 908-276-2225
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Fax | 908-276-1550
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Authorized Official
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Title or Position | PRESIDENT/
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Name | DR. WILLIAM J DERKASCH
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Credential | DDS
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Telephone | 908-276-2225
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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 | 22DI01560000
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License Number State | NJ
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