Organization
GLEN RIDGE COSMETIC AND FAMILY DENTISTRY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LOUIS THEODOROU JR. DMD, FAGD (OWNER)
(973) 743-6092
Entity
Organization
Contact information
Practice address
89 GLEN RIDGE AVE, GLEN RIDGE, NJ 07028-1413
(973) 743-6092
Mailing address
89 GLEN RIDGE AVE, GLEN RIDGE, NJ 07028-1413
(973) 743-6092
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
21675
NJ
Other
Enumeration date
05/01/2008
Last updated
05/01/2008
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