| South Orange Dental Center, P.a. | |
|
481 S Orange Ave South Orange NJ 07079-2642 | |
| (973) 762-2660 | |
| (973) 762-5473 |
| Full Name | South Orange Dental Center, P.a. |
|---|---|
| Speciality | Dentist - Pediatric Dentistry |
| Location | 481 S Orange Ave, South Orange, New Jersey |
| Authorized Official Name and Position | Haniel Rosemond (PRESIDENT) |
| Authorized Official Contact | 9737622660 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| South Orange Dental Center, P.a. 481 S Orange Ave South Orange NJ 07079-2642 Ph: (973) 762-2660 | South Orange Dental Center, P.a. 481 S Orange Ave South Orange NJ 07079-2642 Ph: (973) 762-2660 |
| NPI Number | 1568591162 |
|---|---|
| Provider Enumeration Date | 03/02/2007 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1568591162 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 16564 (New Jersey) | Primary |
| 1223P0221X | Dentist - Pediatric Dentistry | 17250 (New Jersey) | Primary |
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