| Fresh Pediatric Dentistry Pc | |
|
39 South Fullerton Ave Suite 10 Montclair NJ 07042 | |
| (347) 979-2185 | |
| Not Available |
| Full Name | Fresh Pediatric Dentistry Pc |
|---|---|
| Speciality | Dentist - Pediatric Dentistry |
| Location | 39 South Fullerton Ave, Montclair, New Jersey |
| Authorized Official Name and Position | Reesha Patel Shah (OWNER) |
| Authorized Official Contact | 6177085108 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Fresh Pediatric Dentistry Pc 214 50th Ave #507e Long Island City NY 11101-5935 Ph: (617) 708-5108 | Fresh Pediatric Dentistry Pc 39 South Fullerton Ave Suite 10 Montclair NJ 07042 Ph: (347) 979-2185 |
| NPI Number | 1497488985 |
|---|---|
| Provider Enumeration Date | 07/02/2022 |
| Last Update Date | 06/02/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1497488985 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223X0400X | Dentist - Orthodontics And Dentofacial Orthopedics | (* (Not Available)) | Secondary |
| 1223P0221X | Dentist - Pediatric Dentistry | (* (Not Available)) | Primary |
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