Periodontics and Implant Dentistry, PA
NPI #1376617902 in Livingston, New Jersey
Provider Information
- NPI Number
- 1376617902
- Entity Type
- Organization
- Organization Name
- Periodontics and Implant Dentistry, PA
- Primary Specialty
- Dentist - Periodontics
- Enumeration Date
- Nov 17, 2006
- Last Updated
- Aug 22, 2020
Practice Location
- Address
- 160 S LIVINGSTON AVE
- Address 2
- SUITE110-111
- City
- Livingston
- State
- New Jersey
- ZIP Code
- 07039-3033
- Phone
- (973) 994-9995
Authorized Official
- Name
- DR. BARRY DAVID WAGENBERG, DMD
- Title
- PRESIDENT
- Phone
- (973) 994-9995
Specialties & Taxonomy Codes
| Specialty |
|---|
| Dentist - Periodontics — Periodontics |
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