| Willowbrook Mall Dental, Pa | |
|
1445 Willowbrook Blvd Wayne NJ 07470 | |
| (973) 812-4426 | |
| (973) 812-4405 |
| Full Name | Willowbrook Mall Dental, Pa |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 1445 Willowbrook Blvd, Wayne, New Jersey |
| Authorized Official Name and Position | Alexander Mikhailov (OWNER) |
| Authorized Official Contact | 9738124266 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Willowbrook Mall Dental, Pa 1445 Willowbrook Blvd Wayne NJ 07470 Ph: () - | Willowbrook Mall Dental, Pa 1445 Willowbrook Blvd Wayne NJ 07470 Ph: (973) 812-4426 |
| NPI Number | 1174685713 |
|---|---|
| Provider Enumeration Date | 12/13/2006 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1174685713 | NPI | - | NPPES |
| 8345201 | Medicaid | NJ |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 19779 (New Jersey) | Primary |
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