Individual
DR. KENNETH MARK BLUMBERG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
74 ROCKLEDGE DR, LIVINGSTON, NJ 07039-1124
(973) 454-9009
Mailing address
74 ROCKLEDGE DR, LIVINGSTON, NJ 07039-1124
(973) 454-9009
Taxonomy
Speciality
Code
Description
License number
State
1223E0200X
Endodontics
Primary
22DI00861600
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
8616
DENTAL LICENSE
NJ
Enumeration date
03/29/2007
Last updated
07/08/2007
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