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Organization
RANDOLPH ORAL PATHOLOGY ASSOCIATES, LLC
Active
Organization
RANDOLPH ORAL PATHOLOGY ASSOCIATES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JESSICA L WOLLENBERG DMD (SOLE MBR)
(973) 945-9309
Entity
Organization
Contact information
Practice address
447 ROUTE 10, SUITE 5, RANDOLPH, NJ 07869-2132
(973) 328-0464
Mailing address
447 ROUTE 10, SUITE 5, RANDOLPH, NJ 07869-2132
(973) 328-0464
Taxonomy
Speciality
Code
Description
License number
State
1223P0106X
Oral and Maxillofacial Pathology Dentistry
Primary
22DI02546000
NJ
Other
Enumeration date
08/26/2013
Last updated
01/07/2014
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