Healthcare Provider Details

I. General information

NPI: 1023412186
Provider Name (Legal Business Name): AMARA DENTAL OF HOWELL PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2014
Last Update Date: 02/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4538 ROUTE 9 S
HOWELL NJ
07731-3771
US

IV. Provider business mailing address

4538 ROUTE 9 S
HOWELL NJ
07731-3771
US

V. Phone/Fax

Practice location:
  • Phone: 732-806-2026
  • Fax:
Mailing address:
  • Phone: 732-806-2026
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number22DI017432
License Number StateNJ

VIII. Authorized Official

Name: STEPHEN B ABBATICCHIO
Title or Position: OWNER
Credential: DDS
Phone: 732-264-8004