Provider Demographics
NPI:1639165913
Name:PEDIATRIC DENTAL ARTS
Entity Type:Organization
Organization Name:PEDIATRIC DENTAL ARTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:BURRUEZO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:908-470-1700
Mailing Address - Street 1:1 ROBERTSON DR
Mailing Address - Street 2:SUITE 12
Mailing Address - City:BEDMINSTER
Mailing Address - State:NJ
Mailing Address - Zip Code:07921-1716
Mailing Address - Country:US
Mailing Address - Phone:908-470-1700
Mailing Address - Fax:
Practice Address - Street 1:1 ROBERTSON DR
Practice Address - Street 2:SUITE 12
Practice Address - City:BEDMINSTER
Practice Address - State:NJ
Practice Address - Zip Code:07921-1716
Practice Address - Country:US
Practice Address - Phone:908-470-1700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI021773001223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty