MEDICARE: VICTOR H. TRAIN D.D.S.

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	1223P0300X	Periodontics	13089	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	13089	OTHER	NJ	LICENSE

General Provider Information

NPI Number	:	1245457001
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VICTOR H. TRAIN D.D.S.

Provider Business Mailing Address
First Line	:	390 STATE ROUTE 10
Second Line	:	SUITE 102
City	:	RANDOLPH
State	:	NJ
Zip	:	07869-2141
Country	:	US
Telephone Number	:	973-361-6180
Fax Number	:	973-361-6087

Provider Business Practice Location Address
First Line	:	390 STATE ROUTE 10
Second Line	:	SUITE 102
City	:	RANDOLPH
State	:	NJ
Zip	:	07869-2141
Country	:	US
Telephone Number	:	973-361-6180
Fax Number	:	973-361-6087

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/20/2007
Last Update Date	:	03/07/2023

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Directions to “ VICTOR H. TRAIN D.D.S.” Practice Location

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