Organization
DIAMOND BRACES EDISON
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. OLEG DRUT (DOCTOR)
(201) 420-7116
Entity
Organization
Contact information
Practice address
34-36 PROGRESS ST, SUITE A4, EDISON, NJ 08820-1197
(908) 222-8228
(718) 373-6799
Mailing address
15 ENGLE ST, SUITE #303, ENGLEWOOD, NJ 07631-2936
(201) 308-8181
(718) 373-6799
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
22DI2070700
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8072701
—
NJ
Enumeration date
05/13/2014
Last updated
05/13/2014
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