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General NPI Number Information
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NPI Number | 1922272269
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Entity Type | Organization
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Legal Business Name | EAST BRUNSWICK NEW IMAGE DENTAL LLC
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Dates
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Enumeration Date | 04/17/2008
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Last Update Date | 04/17/2008
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Provider Practice Location Address
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Address Line | 444 RYDERS LN
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City | EAST BRUNSWICK
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State | NJ
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Zip | 08816-2765
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Country | US
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Telephone | 732-432-8388
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Fax | 732-432-8366
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Provider Business Mailing Address
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Address Line | 444 RYDERS LN
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City | EAST BRUNSWICK
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State | NJ
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Zip | 08816-2765
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Country | US
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Telephone | 732-432-8388
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Fax | 732-432-8366
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JAEJUNE WOO
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Credential | D.D.S.
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Telephone | 732-432-8388
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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 | DI20877
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License Number State | NJ
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