Organization
RUTGERS HEALTH -UNIVERSITY DENTAL ASSOCIATES
Active
Other names
Rutgers Health Group
Organization subpart
No
Provider details
NPI number
Authorized official
DR. VICENTE H GRACIAS MD (PRESIDENT)
(732) 235-7631
Entity
Organization
Contact information
Practice address
90 BERGEN ST, SUITE 7700, NEWARK, NJ 07103-2425
(973) 972-2444
(973) 972-2441
Mailing address
90 BERGEN ST, SUITE 7700, NEWARK, NJ 07103-2425
(973) 972-8668
(973) 972-2441
Taxonomy
Speciality
Code
Description
License number
State
1223E0200X
Endodontics
Primary
—
—
1223G0001X
General Practice Dentistry
—
—
1223P0300X
Periodontics
—
—
1223P0700X
Prosthodontics
—
—
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
22DI01997900
NJ
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
—
—
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
—
—
124Q00000X
Dental Hygienist
—
—
126800000X
Dental Assistant
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
250009
—
NJ
Enumeration date
05/09/2007
Last updated
07/14/2017
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