| Rejuvenate Dental Sleep Medicine | |
|
266 Harristown Rd Suite 102 Glen Rock NJ 07452-3302 | |
| (201) 652-0400 | |
| (201) 447-5762 |
| Full Name | Rejuvenate Dental Sleep Medicine |
|---|---|
| Speciality | Dentist |
| Location | 266 Harristown Rd, Glen Rock, New Jersey |
| Authorized Official Name and Position | Mayra Modesto-garrido (DENTIST) |
| Authorized Official Contact | 2016520400 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Rejuvenate Dental Sleep Medicine 266 Harristown Rd Suite 102 Glen Rock NJ 07452-3302 Ph: (201) 652-0400 | Rejuvenate Dental Sleep Medicine 266 Harristown Rd Suite 102 Glen Rock NJ 07452-3302 Ph: (201) 652-0400 |
| NPI Number | 1851738736 |
|---|---|
| Provider Enumeration Date | 05/31/2013 |
| Last Update Date | 06/27/2024 |
| Medicare PECOS PAC ID | 9537486899 |
|---|---|
| Medicare Enrollment ID | O20150325001038 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1851738736 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 22DI01825500 (New Jersey) | Primary |
| Provider Name | Mayra Modesto-garrido |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1568524528 PECOS PAC ID: 3375869118 Enrollment ID: I20150325001094 |
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Excel Dentistry, P.c. Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 266 Harristown Rd, Suite 102, Glen Rock, NJ 07452 Phone: 201-652-0400 Fax: 201-447-5762 | |
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