Healthcare Provider Details

I. General information

NPI: 1801097530
Provider Name (Legal Business Name): DOUGLAS S HARTE, DMD, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/30/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 W, MT. PLEASANT AVE.
LIVINGSTON NJ
07039
US

IV. Provider business mailing address

100 W, MT. PLEASANT AVE.
LIVINGSTON NJ
07039
US

V. Phone/Fax

Practice location:
  • Phone: 973-992-7558
  • Fax: 973-992-5833
Mailing address:
  • Phone: 973-992-7558
  • Fax: 973-992-5833

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number22DI00656601
License Number StateNJ

VIII. Authorized Official

Name: DR. DOUGLAS S HARTE
Title or Position: PRESIDENT
Credential: DMD
Phone: 973-992-7558