Organization
GIB SURGICAL CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARY OLIVERIE DMD (OWNER/MEMBER)
(732) 681-0949
Entity
Organization
Contact information
Practice address
1516 STATE ROUTE 138, WALL, NJ 07719-3700
(732) 681-0949
Mailing address
1516 STATE ROUTE 138, WALL, NJ 07719-3700
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DI20496
NJ
Other
Enumeration date
07/10/2012
Last updated
07/10/2012
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