Organization
ALL STAR FAMILY ORTHODONTICS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. VIRGIL JASON VIVES DDS (OWNER)
(732) 727-6666
Entity
Organization
Contact information
Practice address
3331 US HIGHWAY 9, OLD BRIDGE, NJ 08857-2691
(732) 727-6666
Mailing address
3331 HIGHWAY 9 N, OLD BRIDGE, NJ 08857-2691
(732) 727-6666
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
22D102246000
NJ
Other
Enumeration date
12/21/2016
Last updated
12/21/2016
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