Individual
JESSICA LILLIAN WOLLENBERG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.M.D
Contact information
Practice address
447 ROUTE 10, SUITE 5, RANDOLPH, NJ 07869-2132
(973) 328-0464
(973) 328-3405
Mailing address
447 ROUTE 10, SUITE 5, RANDOLPH, NJ 07869-2132
(973) 328-0464
(973) 328-3405
Taxonomy
Speciality
Code
Description
License number
State
1223P0106X
Oral and Maxillofacial Pathology Dentistry
Primary
22DI02546000
NJ
Other
Enumeration date
05/13/2010
Last updated
10/08/2013
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