# MONDOVI DENTAL OF NEW JERSEY - BEJARANO PC

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

## Provider details

- **NPI number:** 1700365129
- **Authorized official:** DIANE MARIE BRION-MARTIN (CREDENTIALING SUPERVISOR)
- **Authorized official phone:** (715) 598-2311

## Contact information

- **Practice address:** 513 BOULEVARD, KENILWORTH, NJ 07033-1637
- **Practice address phone:** (908) 276-6652
- **Practice address fax:** (908) 709-4337
- **Mailing address:** PO BOX 90, MONDOVI, WI 54755-0090
- **Mailing address phone:** (715) 598-2311
- **Mailing address fax:** (715) 350-6855

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | — | — | Yes |

## Other

- **Enumeration date:** 08/07/2018
- **Last updated:** 08/07/2018