Basic Information
| Provider Information | |||||||||
| NPI: | 1225362304 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | EASTERN DENTAL OF HOWELL, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2346 ROUTE 9 SOUTH | ||||||||
| Address2: | |||||||||
| City: | HOWELL | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 07731 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 2346 ROUTE 9 SOUTH | ||||||||
| Address2: | |||||||||
| City: | HOWELL | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 07731 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9999999999 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/23/2009 | ||||||||
| LastUpdateDate: | 09/23/2009 | ||||||||
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| AuthorizedOfficialLastName: | FEILER | ||||||||
| AuthorizedOfficialFirstName: | AARON | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | EXECUTIVE DENTAL DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 9999999999 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | D.D.S | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223S0112X | 10967 | NJ | N | 193200000X MULTI-SPECIALTY GROUP | Dental Providers | Dentist | Oral and Maxillofacial Surgery | 1223G0001X | 20509 | NJ | Y | 193200000X MULTI-SPECIALTY GROUP | Dental Providers | Dentist | General Practice |
No ID Information.