| Precident Of New Jersey, Llc | |
|
1135 Broad St Ste 100 Clifton NJ 07013-3346 | |
| (973) 256-0103 | |
| (973) 256-8066 |
| Full Name | Precident Of New Jersey, Llc |
|---|---|
| Speciality | Dentist - Oral And Maxillofacial Surgery |
| Location | 1135 Broad St Ste 100, Clifton, New Jersey |
| Authorized Official Name and Position | Scotty L Bolding (OWNER) |
| Authorized Official Contact | 4799574611 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Precident Of New Jersey, Llc Po Box 2714 Dept 2243 Conway AR 72033-2714 Ph: (973) 256-0103 | Precident Of New Jersey, Llc 1135 Broad St Ste 100 Clifton NJ 07013-3346 Ph: (973) 256-0103 |
| NPI Number | 1699346437 |
|---|---|
| Provider Enumeration Date | 07/02/2021 |
| Last Update Date | 05/12/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1699346437 | NPI | - | NPPES |
| 22DI02335600 | Other | NJ | NJ STATE LICENSE |
| 22DI02335601 | Other | NJ | NJ STATE LICENSE BRANCH OFFICE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223S0112X | Dentist - Oral And Maxillofacial Surgery | (* (Not Available)) | Primary |
| 204E00000X | Oral & Maxillofacial Surgery | (* (Not Available)) | Secondary |
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