Organization
HERAWATI T KANDOU DDS PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. HERAWATI T KANDOU DDS (PRESIDENT ORTHODONTIST)
(908) 354-1188
Entity
Organization
Contact information
Practice address
35 JEFFERSON AVENUE, ELIZABETH, NJ 07201-2425
(908) 354-1188
(908) 352-7390
Mailing address
35 JEFFERSON AVENUE, ELIZABETH, NJ 07201-2425
(908) 354-1188
(908) 352-7390
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
9708
NJ
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
3026
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
314120901
—
NJ
Enumeration date
11/17/2006
Last updated
05/30/2008
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