Organization
PERIODONTICS AND IMPLANT DENTISTRY, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BARRY DAVID WAGENBERG DMD (PRESIDENT)
(973) 994-9995
Entity
Organization
Contact information
Practice address
160 S LIVINGSTON AVE, SUITE110-111, LIVINGSTON, NJ 07039-3033
(973) 994-9995
(973) 994-1991
Mailing address
160 S LIVINGSTON AVE, SUITE110-111, LIVINGSTON, NJ 07039-3033
(973) 994-9995
(973) 994-1991
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
DI10755
NJ
Other
Enumeration date
11/17/2006
Last updated
08/22/2020
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