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General NPI Number Information
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NPI Number | 1972100220
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Entity Type | Organization
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Legal Business Name | MOUNTAINSIDE DENTAL GROUP
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Dates
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Enumeration Date | 10/08/2020
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Last Update Date | 10/08/2020
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Provider Practice Location Address
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Address Line | 1132 SPRINGFIELD AVE
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City | MOUNTAINSIDE
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State | NJ
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Zip | 07092-2906
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Country | US
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Telephone | 908-581-1571
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Fax |
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Provider Business Mailing Address
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Address Line | 940 DUNHAM AVE
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City | WESTFIELD
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State | NJ
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Zip | 07090-2618
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Country | US
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Telephone | 908-581-1571
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | DR. ROBERT J KUDLA JR.
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Credential | DMD
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Telephone | 908-581-1571
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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 |
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License Number State |
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