# KENILWORTH DENTAL ASSOCIATES, LLC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

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

## Provider details

- **NPI number:** 1710064977
- **Authorized official:** DR. JEROME SCOTT FORMAN D.M.D. (OWNER)
- **Authorized official phone:** (908) 276-6652

## Contact information

- **Practice address:** 513 BOULEVARD, KENILWORTH, NJ 07033-1637
- **Practice address phone:** (908) 276-6652
- **Practice address fax:** (908) 709-4337
- **Mailing address:** 513 BOULEVARD, KENILWORTH, NJ 07033-1637
- **Mailing address phone:** (908) 276-6652
- **Mailing address fax:** (908) 709-4337

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 14638 | NJ | Yes |

## Other

- **Enumeration date:** 11/01/2006
- **Last updated:** 08/22/2020