MEDICARE: MARMORA FAMILY DENTAL ASSOCIATES, PC

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	DI16130	NJ

General Provider Information

NPI Number	:	1295755007
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARMORA FAMILY DENTAL ASSOCIATES, PC

Provider Business Mailing Address
First Line	:	447 ROUTE US 9 S
Second Line	:
City	:	MARMORA
State	:	NJ
Zip	:	08223-1292
Country	:	US
Telephone Number	:	609-390-0111
Fax Number	:	609-390-0727

Provider Business Practice Location Address
First Line	:	447 ROUTE US 9 S
Second Line	:
City	:	MARMORA
State	:	NJ
Zip	:	08223-1292
Country	:	US
Telephone Number	:	609-390-0111
Fax Number	:	609-390-0727

Authorized Official
Title or Position	:	COOWNER
Name	:	DR. ALBERT S HARRIS
Credential	:	DMD
Telephone Number	:	609-390-0111

Provider Enumeration Date	:	07/21/2006
Last Update Date	:	08/22/2020

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