Healthcare Provider Details

I. General information

NPI: 1225030125
Provider Name (Legal Business Name): SHARON M VERDINELLI DMD, FAGD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2005
Last Update Date: 12/29/2020
Certification Date: 10/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1165 MANTUA PIKE
MANTUA NJ
08051-1649
US

IV. Provider business mailing address

1165 MANTUA PIKE
MANTUA NJ
08051-1649
US

V. Phone/Fax

Practice location:
  • Phone: 856-464-1141
  • Fax: 856-464-1223
Mailing address:
  • Phone: 856-464-1141
  • Fax: 856-464-1223

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDS027413L
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number17753
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: