| Glen Ridge Cosmetic And Family Dentistry | |
| 
					89 Glen Ridge Ave Glen Ridge NJ 07028-1413  | |
| (973) 743-6092 | |
| Not Available | 
| Full Name | Glen Ridge Cosmetic And Family Dentistry | 
|---|---|
| Speciality | Dentist | 
| Location | 89 Glen Ridge Ave, Glen Ridge, New Jersey | 
| Authorized Official Name and Position | Louis Theodorou (OWNER) | 
| Authorized Official Contact | 9737436092 | 
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. | 
| Mailing Address | Practice Location Address | 
|---|---|
| Glen Ridge Cosmetic And Family Dentistry 89 Glen Ridge Ave Glen Ridge NJ 07028-1413 Ph: (973) 743-6092  | Glen Ridge Cosmetic And Family Dentistry 89 Glen Ridge Ave Glen Ridge NJ 07028-1413 Ph: (973) 743-6092  | 
| NPI Number | 1083880819 | 
|---|---|
| Provider Enumeration Date | 05/01/2008 | 
| Last Update Date | 05/01/2008 | 
| Identifier | Type | State | Issuer | 
|---|---|---|---|
| 1083880819 | NPI | - | NPPES | 
| Taxonomy | Type | License (State) | Status | 
|---|---|---|---|
| 122300000X | Dentist | 21675 (New Jersey) | Primary |