Individual
MIN PARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
270 MARIN BLVD APT 11Q, JERSEY CITY, NJ 07302-3680
(917) 969-2303
Mailing address
270 MARIN BLVD APT 11Q, JERSEY CITY, NJ 07302-3680
(917) 969-2303
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
22DI02470100
NJ
Other
Enumeration date
05/12/2011
Last updated
05/12/2011
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