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General NPI Number Information
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NPI Number | 1932586914
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Entity Type | Organization
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Legal Business Name | MIDDLETOWN FAMILY DENTAL LLC
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Dates
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Enumeration Date | 04/29/2015
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Last Update Date | 04/29/2015
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Provider Practice Location Address
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Address Line | 766 ROUTE 35
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City | MIDDLETOWN
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State | NJ
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Zip | 07748-3410
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Country | US
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Telephone | 732-945-8283
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Fax | 732-471-6710
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Provider Business Mailing Address
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Address Line | 766 ROUTE 35
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City | MIDDLETOWN
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State | NJ
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Zip | 07748-3410
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Country | US
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Telephone | 732-945-8283
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Fax | 732-471-6710
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MICHELE H QUILTY
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Credential |
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Telephone | 732-945-8283
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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 | 22DI02348100
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License Number State | NJ
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