Provider Demographics
NPI:1518382464
Name:WEMROCK DENTAL ARTS
Entity Type:Organization
Organization Name:WEMROCK DENTAL ARTS
Other - Org Name:FREEHOLD DENTAL ARTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMIISTRATIVE ASSISTANT
Authorized Official - Prefix:MRS
Authorized Official - First Name:LOUISE
Authorized Official - Middle Name:
Authorized Official - Last Name:WAKSMUNDZKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-462-0774
Mailing Address - Street 1:503 STILLWELLS CORNER RD
Mailing Address - Street 2:
Mailing Address - City:FREEHOLD
Mailing Address - State:NJ
Mailing Address - Zip Code:07728-2965
Mailing Address - Country:US
Mailing Address - Phone:732-462-0774
Mailing Address - Fax:
Practice Address - Street 1:503 STILLWELLS CORNER RD
Practice Address - Street 2:
Practice Address - City:FREEHOLD
Practice Address - State:NJ
Practice Address - Zip Code:07728-2965
Practice Address - Country:US
Practice Address - Phone:732-462-0774
Practice Address - Fax:732-462-8775
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-03
Last Update Date:2014-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22D1025584001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty