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Organization
GARDEN STATE OROFACIAL PAIN LLC
Active
Organization
GARDEN STATE OROFACIAL PAIN LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SOWMYA ANANTHAN DMD, MSD (MEMBER)
(732) 345-1800
Entity
Organization
Contact information
Practice address
258 BROAD ST, RED BANK, NJ 07701-2035
(732) 345-1800
Mailing address
26 RENOIR DR, MONMOUTH JUNCTION, NJ 08852-2543
(732) 345-1800
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
DI24531
NJ
Other
Enumeration date
07/14/2016
Last updated
07/14/2016
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