Healthcare Provider Details

I. General information

NPI: 1053631994
Provider Name (Legal Business Name): DENTAL HEALTH ASSOCIATES, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2010
Last Update Date: 06/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5170 RT. 9 S
HOWELL NJ
07731
US

IV. Provider business mailing address

320 SOUTH MAIN STREET CORPORATE OFFICE - 2ND FLR
PHILLIPSBURG NJ
08865
US

V. Phone/Fax

Practice location:
  • Phone: 732-367-8600
  • Fax: 732-367-8606
Mailing address:
  • Phone: 908-387-6120
  • Fax: 908-387-8322

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. CLIFFORD G. LISMAN
Title or Position: PRESIDENT
Credential:
Phone: 908-387-6120