MEDICARE: DR DENTAL OF WEST ORANGE PC

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	:	1558991612
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR DENTAL OF WEST ORANGE PC

Provider Business Mailing Address
First Line	:	945 CONCORD ST STE 230
Second Line	:
City	:	FRAMINGHAM
State	:	MA
Zip	:	01701-4613
Country	:	US
Telephone Number	:	508-620-4563
Fax Number	:	508-297-9083

Provider Business Practice Location Address
First Line	:	495 PROSPECT AVE
Second Line	:
City	:	WEST ORANGE
State	:	NJ
Zip	:	07052-4100
Country	:	US
Telephone Number	:	508-620-4563
Fax Number	:	508-297-9083

Authorized Official
Title or Position	:	ACCT MGR
Name	:	SHEILA CHAMPAGNE
Credential	:
Telephone Number	:	508-620-4563

Provider Enumeration Date	:	01/17/2020
Last Update Date	:	01/17/2020

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