Organization
GROVE STREET DENTAL CARE PC
Active
Other names
Grove Dental Center
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SUSHMA HALTHORE DMD (PRESIDENT)
(201) 200-0222
Entity
Organization
Contact information
Practice address
175 NEWARK AVE, SUITE 2B, JERSEY CITY, NJ 07302-2859
(201) 200-0222
Mailing address
175 NEWARK AVE, SUITE 2B, JERSEY CITY, NJ 07302-2859
(201) 200-0222
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
22DI02366200
NJ
332BC3200X
Customized Equipment (DME)
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0230260
—
NJ
Enumeration date
08/30/2010
Last updated
06/21/2023
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