MEDICARE: AMALGAMATED DENTAL CENTER, 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	1223G0001X	General Practice Dentistry	22DI01000400	NJ

General Provider Information

NPI Number	:	1831312867
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AMALGAMATED DENTAL CENTER, LLC

Provider Business Mailing Address
First Line	:	1379 MORRIS AVE
Second Line	:
City	:	UNION
State	:	NJ
Zip	:	07083-3340
Country	:	US
Telephone Number	:	908-687-5489
Fax Number	:	908-687-5892

Provider Business Practice Location Address
First Line	:	1379 MORRIS AVE
Second Line	:
City	:	UNION
State	:	NJ
Zip	:	07083-3340
Country	:	US
Telephone Number	:	908-687-5489
Fax Number	:	908-687-5892

Authorized Official
Title or Position	:	OWNER
Name	:	DR. GILBERT GLASS
Credential	:	D.M.D.
Telephone Number	:	908-687-5489

Provider Enumeration Date	:	04/10/2007
Last Update Date	:	08/22/2020

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