MEDICARE: HOLLY BEACH DENTAL ASSOCIATES

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	122300000X	Dentist		NJ

General Provider Information

NPI Number	:	1801912647
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOLLY BEACH DENTAL ASSOCIATES

Provider Business Mailing Address
First Line	:	4301 NEW JERSEY AVE
Second Line	:	PO BOX 1326
City	:	WILDWOOD
State	:	NJ
Zip	:	08260-1824
Country	:	US
Telephone Number	:	609-522-1471
Fax Number	:	609-522-5473

Provider Business Practice Location Address
First Line	:	4301 NEW JERSEY AVE
Second Line	:
City	:	WILDWOOD
State	:	NJ
Zip	:	08260-1824
Country	:	US
Telephone Number	:	609-522-1471
Fax Number	:	609-522-5473

Authorized Official
Title or Position	:	SECRETARY
Name	:	DR. FRANK FUSCALDO
Credential	:	DDS
Telephone Number	:	609-522-1471

Provider Enumeration Date	:	03/22/2007
Last Update Date	:	08/22/2020

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