Organization
NJ CANDIC ORTHODONTICS PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RICHARD D'AVANZO (DELEGATED REPRESENTATIVE)
(908) 231-1860
Entity
Organization
Contact information
Practice address
14 BURNISTON CT, HILLSBOROUGH, NJ 08844-2328
(908) 231-1860
Mailing address
14 BURNISTON CT, HILLSBOROUGH, NJ 08844-2328
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00000-00000
N/A
—
Enumeration date
04/02/2019
Last updated
06/11/2019
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