MEDICARE: DR. MARK MESSER D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	22DI01445000	NJ

General Provider Information

NPI Number	:	1144437385
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK MESSER D.D.S.

Provider Business Mailing Address
First Line	:	1 JASON DR
Second Line	:
City	:	EAST BRUNSWICK
State	:	NJ
Zip	:	08816-3342
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2080 OAK TREE ROAD
Second Line	:
City	:	EDISON
State	:	NJ
Zip	:	08820
Country	:	US
Telephone Number	:	732-549-5660
Fax Number	:	732-494-9403

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/17/2007
Last Update Date	:	07/08/2007

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