MEDICARE: TOWNSHIP OF WEST ORANGE DENTAL CLINIC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QD0000X	Dental Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1013130574
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TOWNSHIP OF WEST ORANGE DENTAL CLINIC

Provider Business Mailing Address
First Line	:	66 MAIN ST
Second Line	:
City	:	WEST ORANGE
State	:	NJ
Zip	:	07052-5404
Country	:	US
Telephone Number	:	973-325-4135
Fax Number	:	973-325-4005

Provider Business Practice Location Address
First Line	:	66 MAIN ST
Second Line	:
City	:	WEST ORANGE
State	:	NJ
Zip	:	07052-5404
Country	:	US
Telephone Number	:	973-325-4135
Fax Number	:	973-325-4005

Authorized Official
Title or Position	:	DIRECTOR OF HEALTH & WELFARE
Name	:	MR. JOSEPH A. FONZINO
Credential	:
Telephone Number	:	973-325-4124

Provider Enumeration Date	:	04/11/2007
Last Update Date	:	08/22/2020

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Directions to “TOWNSHIP OF WEST ORANGE DENTAL CLINIC ” Practice Location

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