Organization
ELBASTY PEDIATRIC AN DENTA ASSOC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MOHAMED A. ELBASTY DDS, MS (PRESIDENT)
(732) 615-0700
Entity
Organization
Contact information
Practice address
100 COMMONS WAY, SUITE 130, HOLMDEL, NJ 07733
(732) 615-0700
Mailing address
100 COMMONS WAY, SUITE 130, HOLMDEL, NJ 07733
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
19874
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0023035
—
NJ
Enumeration date
07/09/2009
Last updated
07/09/2009
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