Organization
MONTCLAIR DENTAL SPA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. YOUSEF MOUSSA (OWNER/DENTIST)
(973) 744-1527
Entity
Organization
Contact information
Practice address
204 CLAREMONT AVE, MONTCLAIR, NJ 07042-3409
(973) 744-1527
Mailing address
204 CLAREMONT AVE, MONTCLAIR, NJ 07042-3409
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
1223P0106X
Oral and Maxillofacial Pathology Dentistry
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1588703052
NPPES
NJ
Enumeration date
05/10/2019
Last updated
06/11/2019
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