MEDICARE: DUO DENTAL GROUP OF UNION LLC

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

General Provider Information

NPI Number	:	1124627856
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DUO DENTAL GROUP OF UNION LLC

Provider Business Mailing Address
First Line	:	990 RAHWAY AVE
Second Line	:
City	:	UNION
State	:	NJ
Zip	:	07083-6546
Country	:	US
Telephone Number	:	908-687-2332
Fax Number	:

Provider Business Practice Location Address
First Line	:	990 RAHWAY AVE
Second Line	:
City	:	UNION
State	:	NJ
Zip	:	07083-6546
Country	:	US
Telephone Number	:	908-687-2332
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. CHARLES MATARAZZO
Credential	:	DMD
Telephone Number	:	908-687-2332

Provider Enumeration Date	:	10/23/2020
Last Update Date	:	10/23/2020

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Directions to “DUO DENTAL GROUP OF UNION LLC ” Practice Location

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