# PEB DENTAL DDS PA

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

## Provider details

- **NPI number:** 1770971103
- **Authorized official:** DR. VIJAYA RADAKRISHNA M.D. (PEDIATRICIAN)
- **Authorized official phone:** (732) 752-1932

## Contact information

- **Practice address:** 230 ROUTE 18, EAST BRUNSWICK, NJ 08816-1909
- **Practice address phone:** (732) 609-9106
- **Practice address fax:** (732) 752-1268
- **Mailing address:** 230 ROUTE 18, EAST BRUNSWICK, NJ 08816-1909
- **Mailing address phone:** (732) 609-9106
- **Mailing address fax:** (732) 752-1268

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 0101028295 | NJ | Yes |

## Other

- **Enumeration date:** 01/08/2015
- **Last updated:** 01/08/2015