Provider Demographics
NPI:1649300500
Name:STELTON DENTAL CENTER
Entity type:Organization
Organization Name:STELTON DENTAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:C
Authorized Official - Last Name:CHANG
Authorized Official - Suffix:
Authorized Official - Credentials:DMDMS
Authorized Official - Phone:732-777-0660
Mailing Address - Street 1:1100 STELTON RD
Mailing Address - Street 2:
Mailing Address - City:PISCATAWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:08854-5202
Mailing Address - Country:US
Mailing Address - Phone:732-777-0660
Mailing Address - Fax:732-777-0609
Practice Address - Street 1:1100 STELTON RD
Practice Address - Street 2:
Practice Address - City:PISCATAWAY
Practice Address - State:NJ
Practice Address - Zip Code:08854-5202
Practice Address - Country:US
Practice Address - Phone:732-777-0660
Practice Address - Fax:732-777-0609
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2011-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI020395001223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty