Healthcare Provider Details

I. General information

NPI: 1558373225
Provider Name (Legal Business Name): THOMAS S DILAURO DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 DE MERCURIO DR SUITE 7
ALLENDALE NJ
07401-1717
US

IV. Provider business mailing address

1 DE MERCURIO DRIVE SUITE 7
ALLENDALE NJ
07401-1717
US

V. Phone/Fax

Practice location:
  • Phone: 201-825-9229
  • Fax: 201-934-1820
Mailing address:
  • Phone: 201-825-9229
  • Fax: 201-934-1820

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDI011388
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: