Healthcare Provider Details

I. General information

NPI: 1396868154
Provider Name (Legal Business Name): MARLBORO DENTAL ARTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

242 STATE ROUTE 79 N SUITE 7
MORGANVILLE NJ
07751-2078
US

IV. Provider business mailing address

242 STATE ROUTE 79 N SUITE 7
MORGANVILLE NJ
07751
US

V. Phone/Fax

Practice location:
  • Phone: 732-817-1100
  • Fax: 732-817-1102
Mailing address:
  • Phone: 732-817-1100
  • Fax: 732-817-1102

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDI02239800
License Number StateNJ

VIII. Authorized Official

Name: DR. STEPHEN ABBATICCHIO
Title or Position: OWNER
Credential: D.D.S.
Phone: 732-817-1100