MEDICARE: BERKELEY COSMETIC IMPLANT AND FAMILY DENTISTRY, P.C.

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	261QS0112X	Oral and Maxillofacial Surgery Clinic/Center	22DI00891100	NJ

General Provider Information

NPI Number	:	1184959041
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BERKELEY COSMETIC IMPLANT AND FAMILY DENTISTRY, P.C.

Provider Business Mailing Address
First Line	:	261 SPRINGFIELD AVE
Second Line	:	SUITE 100
City	:	BERKELEY HEIGHTS
State	:	NJ
Zip	:	07922-1264
Country	:	US
Telephone Number	:	908-464-8333
Fax Number	:	908-464-0339

Provider Business Practice Location Address
First Line	:	261 SPRINGFIELD AVE
Second Line	:	SUITE 100
City	:	BERKELEY HEIGHTS
State	:	NJ
Zip	:	07922-1264
Country	:	US
Telephone Number	:	908-464-8333
Fax Number	:	908-464-0339

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ALBERT A. GALANTE
Credential	:	D.M.D
Telephone Number	:	908-464-8333

Provider Enumeration Date	:	10/11/2009
Last Update Date	:	04/03/2013

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