# EAST BRUNSWICK DENTAL STUDIO, LLC

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

## Provider details

- **NPI number:** 1841319209
- **Authorized official:** GENEVIEVE M FERNANDES B.D.S., D.D.S. (DENTIST)
- **Authorized official phone:** (732) 613-1931

## Contact information

- **Practice address:** 573 CRANBURY RD, SUITE A-1, EAST BRUNSWICK, NJ 08816-4026
- **Practice address phone:** (732) 613-1931
- **Mailing address:** 573 CRANBURY RD, SUITE A-1, EAST BRUNSWICK, NJ 08816-4026
- **Mailing address phone:** (732) 613-1931

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | DI19669 | NJ | Yes |

## Other

- **Enumeration date:** 03/28/2007
- **Last updated:** 11/03/2009