MEDICARE: EASTERN DENTAL OF HOWELL, 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	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	10967	NJ
2	1223G0001X	General Practice Dentistry	20509	NJ

General Provider Information

NPI Number	:	1225362304
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EASTERN DENTAL OF HOWELL, LLC

Provider Business Mailing Address
First Line	:	2346 ROUTE 9 SOUTH
Second Line	:
City	:	HOWELL
State	:	NJ
Zip	:	07731
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2346 ROUTE 9 SOUTH
Second Line	:
City	:	HOWELL
State	:	NJ
Zip	:	07731
Country	:	US
Telephone Number	:	999-999-9999
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DENTAL DIRECTOR
Name	:	AARON FEILER
Credential	:	D.D.S
Telephone Number	:	999-999-9999

Provider Enumeration Date	:	09/23/2009
Last Update Date	:	09/23/2009

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