Organization
GARDEN STATE OROFACIAL PAIN LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SOWMYA ANANTHAN DMD, MSD (MEMBER)
(732) 345-1800
Entity
Organization
Contact information
Practice address
258 BROAD ST, RED BANK, NJ 07701-2035
(732) 345-1800
Mailing address
26 RENOIR DR, MONMOUTH JUNCTION, NJ 08852-2543
(732) 345-1800
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
DI24531
NJ
Other
Enumeration date
07/14/2016
Last updated
07/14/2016
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