# MONTCLAIR DENTAL SPA

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1366008864
- **Authorized official:** DR. YOUSEF MOUSSA (OWNER/DENTIST)
- **Authorized official phone:** (973) 744-1527

## Contact information

- **Practice address:** 204 CLAREMONT AVE, MONTCLAIR, NJ 07042-3409
- **Practice address phone:** (973) 744-1527
- **Mailing address:** 204 CLAREMONT AVE, MONTCLAIR, NJ 07042-3409

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | — | — | Yes |
| 1223P0106X | Oral and Maxillofacial Pathology Dentistry | — | — | — |

## Other

- **Enumeration date:** 05/10/2019
- **Last updated:** 06/11/2019

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 1588703052 | NPPES | NJ |