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Organization
LTC MOBILE DENTAL SERVICES, P.A.
Active
Organization
LTC MOBILE DENTAL SERVICES, P.A.
Active
Other names
LTC MOBILE DENTAL SERVICES, P.A.
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RAMA E. GVILDYS DMD (PRESIDENT)
(551) 404-5769
Entity
Organization
Contact information
Practice address
1961 MORRIS AVE, SUITE A-7, UNION, NJ 07083-3531
(551) 404-5769
(866) 810-8101
Mailing address
1961 MORRIS AVE, SUITE A-7, UNION, NJ 07083-3531
(551) 404-5769
(866) 810-8101
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
22DI01820201
NJ
122300000X
Dentist
22DI02289100
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1285785006
—
NJ
05
—
1427108307
—
NJ
05
—
1700917127
—
NJ
Enumeration date
02/23/2010
Last updated
09/01/2011
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