Individual
DR. LARISSA BOGOMOLNY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
29 BRUNSWICK WOODS DR, EAST BRUNSWICK, NJ 08816-5601
(732) 718-3676
Mailing address
6 PERIWINKLE CT, EAST BRUNSWICK, NJ 08816-2783
(732) 718-3676
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
22DI02420200
NJ
Other
Enumeration date
11/05/2009
Last updated
08/02/2011
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