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General NPI Number Information
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NPI Number | 1891175253
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Entity Type | Organization
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Legal Business Name | WAYNE FAMILY DENTAL
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Dates
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Enumeration Date | 06/01/2015
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Last Update Date | 06/01/2015
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Provider Practice Location Address
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Address Line | 931 HAMBURG TPKE
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City | WAYNE
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State | NJ
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Zip | 07470-3222
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Country | US
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Telephone | 973-694-4494
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Fax | 973-694-4495
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Provider Business Mailing Address
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Address Line | 931 HAMBURG TPKE
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City | WAYNE
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State | NJ
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Zip | 07470-3222
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Country | US
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Telephone | 973-694-4494
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Fax | 973-694-4495
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Authorized Official
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Title or Position | DENTIST
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Name | DR. JAMES CHOE
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Credential | D.D.S
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Telephone | 973-694-4497
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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 | DI020028
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License Number State | NJ
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