| Organization Name: | MANVILLE DENTAL GROUP LLC |
| NPI Number: | 1043481039 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JOHN K CHEN (MANAGING MEMBER) |
| Mailing Address: | 7 Washington Ave Manville |
| State: | NJ US |
| Postal Code: | 088351984 |
| Phone Number: | 9087226500 |
| Fax Number: | 9087227206 |
| NPI Enumeration Date: | 03/18/2008 |
| NPI Last Update Date: | 03/18/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QD0000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Dental |
| Taxonomy Definition: | |