Individual
EVAN MAST
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
105 ELMORA AVE, ELIZABETH, NJ 07202-1614
(908) 402-0878
Mailing address
302 FOXWOOD RD, UNION, NJ 07083-7941
(908) 418-8527
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
22DI02819700
NJ
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/27/2020
Last updated
07/12/2021
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