Organization
SENIOR CARE DENTAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. ANNETTE SANTIAGO (SUPERVISOR BILLER)
(973) 446-0620
Entity
Organization
Contact information
Practice address
345 PASSAIC AVE, 1ST FL, LODI, NJ 07644
(973) 446-0620
(973) 446-0620
Mailing address
93 HOME PLACE, 1ST FL, LODI, NJ 07644
(973) 446-0620
(973) 446-0620
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0014931
—
NJ
Enumeration date
11/14/2006
Last updated
08/22/2020
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