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General NPI Number Information
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NPI Number | 1942481676
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Entity Type | Organization
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Legal Business Name | SPOTSWOOD FAMILY DENTAL LLC.
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Dates
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Enumeration Date | 11/22/2007
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Last Update Date | 01/28/2013
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Provider Practice Location Address
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Address Line | 2 AUER CT STE C
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City | EAST BRUNSWICK
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State | NJ
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Zip | 08816-5824
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Country | US
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Telephone | 732-251-6010
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Fax | 732-251-6016
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Provider Business Mailing Address
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Address Line | 2 AUER CT STE C
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City | EAST BRUNSWICK
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State | NJ
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Zip | 08816-5824
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DENTIST DDS
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Name | DR. MAGGIE KASISA
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Credential |
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Telephone | 732-251-6010
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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 | 22DI02209900
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License Number State | NJ
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