Individual
ERWIN PARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
28 JACKSON AVE STE 1, POMPTON PLAINS, NJ 07444-1479
(973) 831-0382
Mailing address
28 JACKSON AVE STE 1, POMPTON PLAINS, NJ 07444-1479
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
22DI02740400
NJ
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
06/06/2013
Last updated
07/16/2019
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