Provider Demographics
NPI:1972928000
Name:EDISON DENTISTRY PC
Entity Type:Organization
Organization Name:EDISON DENTISTRY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RUOJUN
Authorized Official - Middle Name:
Authorized Official - Last Name:HUANG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:732-339-1711
Mailing Address - Street 1:1719A LINCOLN HIGHWAY
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08817-3471
Mailing Address - Country:US
Mailing Address - Phone:732-339-1711
Mailing Address - Fax:732-339-1713
Practice Address - Street 1:1719A LINCOLN HIGHWAY
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08817-3471
Practice Address - Country:US
Practice Address - Phone:732-339-1711
Practice Address - Fax:732-339-1713
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-26
Last Update Date:2014-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI02466300122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty