# REJUVENATE DENTAL SLEEP MEDICINE

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

## Provider details

- **NPI number:** 1851738736
- **Authorized official:** MAYRA MODESTO-GARRIDO D.D.S. (DENTIST)
- **Authorized official phone:** (201) 652-0400

## Contact information

- **Practice address:** 266 HARRISTOWN RD, SUITE 102, GLEN ROCK, NJ 07452-3302
- **Practice address phone:** (201) 652-0400
- **Practice address fax:** (201) 447-5762
- **Mailing address:** 266 HARRISTOWN RD, SUITE 102, GLEN ROCK, NJ 07452-3302
- **Mailing address phone:** (201) 652-0400
- **Mailing address fax:** (201) 447-5762

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 22DI01825500 | NJ | Yes |

## Other

- **Enumeration date:** 05/31/2013
- **Last updated:** 06/27/2024