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General NPI Number Information
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NPI Number | 1992879498
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Entity Type | Individual
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Provider Name | DONALD E KONDRAT DMD
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Gender | Male
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Dates
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Enumeration Date | 11/17/2006
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 86 MARKET ST
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City | CLIFTON
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State | NJ
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Zip | 07012-2404
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Country | US
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Telephone | 973-777-8117
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Fax |
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Provider Business Mailing Address
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Address Line | 277 LAKE WALLKILL RD
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City | SUSSEX
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State | NJ
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Zip | 07461-4609
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Country | US
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Telephone | 973-875-1036
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 22DI00977201
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License Number State | NJ
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