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NPI Code Detail

MEDICARE: RUTGERS SCHOOL OF DENTAL MEDICINE

MEDICARE: RUTGERS SCHOOL OF DENTAL MEDICINE
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
1261QD0000XDental Clinic/Center

Other Identifiers

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

General Provider Information

NPI Number : 1407069107
Entity Type Code : Organization
Provider Name (Legal Business Name) : RUTGERS SCHOOL OF DENTAL MEDICINE
Provider Business Mailing Address
First Line : 110 BERGEN ST
Second Line : RSDM ROOM D-954
City : NEWARK
State : NJ
Zip : 07103-2495
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 235 DOLPHIN AVE
Second Line :
City : NORTHFIELD
State : NJ
Zip : 08225-2015
Country : US
Telephone Number : 609-645-5814
Fax Number : 609-645-5872
Authorized Official
Title or Position : CODE DIRECTOR
Name : DR. DAVID BOLGER
Credential : DMD
Telephone Number : 609-645-5814
Provider Enumeration Date : 05/08/2007
Last Update Date : 05/09/2014

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Directions to “RUTGERS SCHOOL OF DENTAL MEDICINE ” Practice Location

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