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NPI Code Detail

MEDICARE: MARLBORO PEDIATRIC DENTISTRY, PC

MEDICARE: MARLBORO PEDIATRIC DENTISTRY, 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
1122300000XDentist22DI02447000NJ

General Provider Information

NPI Number : 1982078762
Entity Type Code : Organization
Provider Name (Legal Business Name) : MARLBORO PEDIATRIC DENTISTRY, PC
Provider Business Mailing Address
First Line : 7 S MAIN ST
Second Line : SUITE G
City : MARLBORO
State : NJ
Zip : 07746-1578
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 7 S MAIN ST
Second Line : SUITE G
City : MARLBORO
State : NJ
Zip : 07746-1578
Country : US
Telephone Number : 732-414-6900
Fax Number :
Authorized Official
Title or Position : OWNER
Name : DR. YANA KOZLOVSKY
Credential : DMD
Telephone Number : 732-414-6900
Provider Enumeration Date : 11/17/2015
Last Update Date : 11/17/2015

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Directions to “MARLBORO PEDIATRIC DENTISTRY, PC ” Practice Location

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