Organization
OLD BRIDGE FAMILY ORTHODONTICS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
VIRGIL JASON VIVES DDS (ORTHODONTIST)
(732) 727-6666
Entity
Organization
Contact information
Practice address
28 THROCKMORTON LN, SUITE 104, OLD BRIDGE, NJ 08857-2558
(732) 727-6666
(732) 679-5522
Mailing address
28 THROCKMORTON LN, SUITE 104, OLD BRIDGE, NJ 08857-2558
(732) 727-6666
(732) 679-5522
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
22DIO46000
NJ
Other
Enumeration date
04/26/2010
Last updated
04/26/2010
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