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Organization

EXCEL DENTISTRY, P.C.

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MAYRA MODESTO-GARRIDO D.D.S. (DENTIST)
(201) 652-0400
Entity
Organization

Contact information

Practice address
266 HARRISTOWN RD, SUITE 102, GLEN ROCK, NJ 07452-3302
(201) 652-0400
(201) 447-5762
Mailing address
266 HARRISTOWN RD, SUITE 102, GLEN ROCK, NJ 07452-3302
(201) 652-0400
(201) 447-5762

Taxonomy

Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
22DI01825501
NJ

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
0066028
NJ
05
6037704
NJ
01
898217
UNITED CONCORDIA
NJ
Enumeration date
12/15/2006
Last updated
02/12/2015
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