Organization
METROPOLITAN CRANIOFACIAL CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. THEODORE A NIEBLOOM DMD (DOCTOR VP)
(973) 736-7616
Entity
Organization
Contact information
Practice address
101 OLD SHORT HILLS ROAD, PENTHOUSE II, WEST ORANGE, NJ 07052
(973) 736-7616
(973) 325-3487
Mailing address
101 OLD SHORT HILLS ROAD, PENTHOUSE II, WEST ORANGE, NJ 07052
(973) 736-7616
(973) 325-3487
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
—
—
Other
Enumeration date
10/31/2006
Last updated
10/05/2016
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