Organization
EAST BRUNSWICK PERIODONTICS AND DENTAL IMPLANTS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. NIMA MIR MADJLESSI DDS, MS, PA (DOCTOR)
(732) 651-8470
Entity
Organization
Contact information
Practice address
E 7 BRIER HILL CT, EAST BRUNSWICK, NJ 08816-3336
(732) 651-8470
(732) 651-8033
Mailing address
E 7 BRIER HILL CT, EAST BRUNSWICK, NJ 08816-3336
(732) 651-8470
(732) 651-8033
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
20508
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1659303329
NATIONAL PROVIDER IDENTIF
NJ
Enumeration date
01/30/2007
Last updated
08/22/2020
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