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Organization
PERIODONTICS AND IMPLANT DENTISTRY, PA
Active
Organization
PERIODONTICS AND IMPLANT DENTISTRY, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BARRY DAVID WAGENBERG DMD (PRESIDENT)
(973) 994-9995
Entity
Organization
Contact information
Practice address
160 S LIVINGSTON AVE, SUITE110-111, LIVINGSTON, NJ 07039-3033
(973) 994-9995
(973) 994-1991
Mailing address
160 S LIVINGSTON AVE, SUITE110-111, LIVINGSTON, NJ 07039-3033
(973) 994-9995
(973) 994-1991
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
DI10755
NJ
Other
Enumeration date
11/17/2006
Last updated
08/22/2020
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