| Periodontics And Implant Dentistry, Pa | |
|
160 S Livingston Ave Suite110-111 Livingston NJ 07039-3033 | |
| (973) 994-9995 | |
| (973) 994-1991 |
| Full Name | Periodontics And Implant Dentistry, Pa |
|---|---|
| Speciality | Dentist - Periodontics |
| Location | 160 S Livingston Ave, Livingston, New Jersey |
| Authorized Official Name and Position | Barry David Wagenberg (PRESIDENT) |
| Authorized Official Contact | 9739949995 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Periodontics And Implant Dentistry, Pa 160 S Livingston Ave Suite110-111 Livingston NJ 07039-3033 Ph: (973) 994-9995 | Periodontics And Implant Dentistry, Pa 160 S Livingston Ave Suite110-111 Livingston NJ 07039-3033 Ph: (973) 994-9995 |
| NPI Number | 1376617902 |
|---|---|
| Provider Enumeration Date | 11/17/2006 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1376617902 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0300X | Dentist - Periodontics | DI10755 (New Jersey) | Primary |
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