Organization
MONTCLAIR ORTHODONTICS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JOHN CHRISTOPHER RUBINO (PRACTICE MANAGER)
(973) 744-1912
Entity
Organization
Contact information
Practice address
218 LORRAINE AVE, UPPER MONTCLAIR, NJ 07043-1915
(973) 744-1912
(973) 744-5955
Mailing address
218 LORRAINE AVE, UPPER MONTCLAIR, NJ 07043-1915
(973) 744-1912
(973) 744-5955
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1134251606
NPPES
—
01
—
1396930855
NPPES
—
01
—
22DI01426800
NJ STATE BOARD OF DENTISTRY
NJ
01
—
22DI02349400
NJ STATE BOARD OF DENTISTRY
NJ
Enumeration date
03/06/2023
Last updated
03/09/2023
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