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Organization
BERGEN DENTAL PRACTICE, P.C.
Active
Organization
BERGEN DENTAL PRACTICE, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MOHAMMED MANSOORUL IMAM DDS (PRESIDENT)
(201) 385-0013
Entity
Organization
Contact information
Practice address
21 MAGNOLIA ST, BERGENFIELD, NJ 07621-3812
(201) 385-0013
(201) 385-0842
Mailing address
21 MAGNOLIA ST, BERGENFIELD, NJ 07621-3812
(201) 385-0013
(201) 385-0842
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
20895
NJ
Other
Enumeration date
06/09/2008
Last updated
06/09/2008
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