Healthcare Provider Details

I. General information

NPI: 1508012147
Provider Name (Legal Business Name): BARBARA A FODERO, DDS, MS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2008
Last Update Date: 08/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33 MAIN ST SUITE 104
CHATHAM NJ
07928-2433
US

IV. Provider business mailing address

33 MAIN ST SUITE 104
CHATHAM NJ
07928-2433
US

V. Phone/Fax

Practice location:
  • Phone: 973-701-2200
  • Fax: 973-701-2210
Mailing address:
  • Phone: 973-701-2200
  • Fax: 973-701-2210

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberDI021124
License Number StateNJ

VIII. Authorized Official

Name: DR. BARBARA A FODERO
Title or Position: PRESIDENT
Credential: DDS, MS
Phone: 973-701-2200