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General NPI Number Information
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NPI Number | 1982723748
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Entity Type | Organization
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Legal Business Name | MONROE PEDIATRIC DENTAL CENTER
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Dates
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Enumeration Date | 03/29/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 18 CENTRE DRIVE SUITE 204
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City | MONROE TOWNSHIP
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State | NJ
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Zip | 08831
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Country | US
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Telephone | 609-409-0499
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Fax | 609-409-7499
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Provider Business Mailing Address
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Address Line | 18 CENTRE DRIVE SUITE 204
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City | MONROE TOWNSHIP
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State | NJ
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Zip | 08831
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Country | US
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Telephone | 609-409-0499
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Fax | 609-409-7499
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Authorized Official
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Title or Position | DENTIST
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Name | DR. LISA BETH SOBEL
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Credential | D.M.D.
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Telephone | 609-409-0499
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 22DI02140600
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License Number State | NJ
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