| Mill Road Dental Center Pc | |
|
5 Mill Road Irvington NJ 07111 | |
| (973) 372-7049 | |
| (973) 372-7961 |
| Full Name | Mill Road Dental Center Pc |
|---|---|
| Speciality | Dentist |
| Location | 5 Mill Road, Irvington, New Jersey |
| Authorized Official Name and Position | Yeugeny Audeychik (DENTIST) |
| Authorized Official Contact | 9733727049 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Mill Road Dental Center Pc 5 Mill Road Irvington NJ 07111 Ph: (973) 372-7049 | Mill Road Dental Center Pc 5 Mill Road Irvington NJ 07111 Ph: (973) 372-7049 |
| NPI Number | 1184789125 |
|---|---|
| Provider Enumeration Date | 12/27/2006 |
| Last Update Date | 05/07/2013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1184789125 | NPI | - | NPPES |
| 636150101 | Medicaid | NJ |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 19161 (New Jersey) | Primary |
| 122300000X | Dentist | 19119 (New Jersey) | Secondary |
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