Provider Demographics
NPI:1720680283
Name:MB DENTAL OMS LLC
Entity Type:Organization
Organization Name:MB DENTAL OMS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNY
Authorized Official - Middle Name:
Authorized Official - Last Name:LAU
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:973-808-1228
Mailing Address - Street 1:380 FAIRFIELD RD
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07004-1934
Mailing Address - Country:US
Mailing Address - Phone:973-808-1228
Mailing Address - Fax:973-402-0595
Practice Address - Street 1:380 FAIRFIELD RD
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07004-1934
Practice Address - Country:US
Practice Address - Phone:973-808-1228
Practice Address - Fax:973-402-0595
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-10
Last Update Date:2020-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty