Provider Demographics
NPI:1356629638
Name:MONTVILLE ENDODONTICS, LLC
Entity Type:Organization
Organization Name:MONTVILLE ENDODONTICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARC
Authorized Official - Middle Name:P
Authorized Official - Last Name:GIMBEL
Authorized Official - Suffix:
Authorized Official - Credentials:D,MD
Authorized Official - Phone:973-335-6408
Mailing Address - Street 1:150 RIVER RD
Mailing Address - Street 2:K-3
Mailing Address - City:MONTVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07045-9441
Mailing Address - Country:US
Mailing Address - Phone:973-335-6408
Mailing Address - Fax:973-335-8246
Practice Address - Street 1:150 RIVER RD
Practice Address - Street 2:K-3
Practice Address - City:MONTVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07045-9441
Practice Address - Country:US
Practice Address - Phone:973-335-6408
Practice Address - Fax:973-335-8246
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-03
Last Update Date:2011-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty