Healthcare Provider Details

I. General information

NPI: 1578535670
Provider Name (Legal Business Name): JOHN FRATTELLONE DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 NEWMAN SPRINGS RD
LINCROFT NJ
07738-1426
US

IV. Provider business mailing address

515 NEWMAN SPRINGS RD
LINCROFT NJ
07738-1426
US

V. Phone/Fax

Practice location:
  • Phone: 732-842-5915
  • Fax: 732-842-5910
Mailing address:
  • Phone: 732-842-5915
  • Fax: 732-842-5910

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number16514
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: