| Ltc Mobile Dental Services, P.a. | |
|
1961 Morris Ave Suite A-7 Union NJ 07083-3531 | |
| (551) 404-5769 | |
| (866) 810-8101 |
| Full Name | Ltc Mobile Dental Services, P.a. |
|---|---|
| Speciality | Dentist |
| Location | 1961 Morris Ave, Union, New Jersey |
| Authorized Official Name and Position | Rama E. Gvildys (PRESIDENT) |
| Authorized Official Contact | 5514045769 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Ltc Mobile Dental Services, P.a. 1961 Morris Ave Suite A-7 Union NJ 07083-3531 Ph: (551) 404-5769 | Ltc Mobile Dental Services, P.a. 1961 Morris Ave Suite A-7 Union NJ 07083-3531 Ph: (551) 404-5769 |
| NPI Number | 1083936611 |
|---|---|
| Provider Enumeration Date | 02/23/2010 |
| Last Update Date | 09/01/2011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1083936611 | NPI | - | NPPES |
| 1427108307 | Medicaid | NJ | |
| 1700917127 | Medicaid | NJ | |
| 1285785006 | Medicaid | NJ |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 22DI01820201 (New Jersey) | Primary |
| 122300000X | Dentist | 22DI02289100 (New Jersey) | Secondary |
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