Organization
KENILWORTH DENTAL ASSOCIATES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JEROME SCOTT FORMAN D.M.D. (OWNER)
(908) 276-6652
Entity
Organization
Contact information
Practice address
513 BOULEVARD, KENILWORTH, NJ 07033-1637
(908) 276-6652
(908) 709-4337
Mailing address
513 BOULEVARD, KENILWORTH, NJ 07033-1637
(908) 276-6652
(908) 709-4337
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
14638
NJ
Other
Enumeration date
11/01/2006
Last updated
08/22/2020
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