Individual
SANDI GRACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
201 LYONS AVE, NEWARK, NJ 07112-2027
(800) 843-2384
Mailing address
201 LYONS AVE, NEWARK, NJ 07112-2027
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
22DI02868400
NJ
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/14/2021
Last updated
04/17/2024
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