Provider First Line Business Practice Location Address:
110 BERGEN STREET, RUTGERS SCHOOL OF DENTAL MEDICINE
Provider Second Line Business Practice Location Address:
DEPARTMENT OF ORTHODONTICS - ROOM C781
Provider Business Practice Location Address City Name:
NEWARK
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07103
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-972-4704
Provider Business Practice Location Address Fax Number:
973-972-9402
Provider Enumeration Date:
08/10/2015