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Organization
DENTAL MENTORS
Active
Organization
DENTAL MENTORS
Active
Other names
Dental Sleep Alternatives
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOHN A TALTAVALL III DMD (PARTNER)
(973) 628-1449
Entity
Organization
Contact information
Practice address
166 MAIN ST, SUITE 1B, LINCOLN PARK, NJ 07035-3707
(973) 628-1449
(973) 696-0037
Mailing address
PO BOX 457, 166 MAIN STREET SUITE 1B, LINCOLN PARK, NJ 07035-0457
(973) 628-1449
(973) 696-0037
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
DI18175
NJ
261QD0000X
Dental Clinic/Center
Primary
DI18340
NJ
Other
Enumeration date
01/27/2014
Last updated
10/05/2015
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