Organization
INTEGRATED DENTAL AESTETICS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ROBERT A LOGAN (DENTIST/OWNER)
(973) 838-4460
Entity
Organization
Contact information
Practice address
11 KIEL AVE, KINNELON, NJ 07405-2549
(973) 838-4460
(973) 838-6258
Mailing address
11 KIEL AVE, KINNELON, NJ 07405-2549
(973) 838-4460
(973) 838-6258
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
10617
NJ
Other
Enumeration date
06/16/2008
Last updated
09/17/2013
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