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General NPI Number Information
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NPI Number | 1982087656
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Entity Type | Organization
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Legal Business Name | BGAW TREATMENT
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Dates
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Enumeration Date | 06/30/2015
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Last Update Date | 06/30/2015
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Provider Practice Location Address
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Address Line | 206 MONTROSE AVE
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City | SOUTH ORANGE
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State | NJ
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Zip | 07079-2417
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Country | US
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Telephone | 973-640-0732
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Fax |
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Provider Business Mailing Address
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Address Line | 206 MONTROSE AVE
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City | SOUTH ORANGE
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State | NJ
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Zip | 07079-2417
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Country | US
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Telephone | 973-640-0732
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | BARRY GLASSMAN
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Credential | DDS
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Telephone | 908-258-0341
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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 | DI018205
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License Number State | PA
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