Healthcare Provider Details

I. General information

NPI: 1497825558
Provider Name (Legal Business Name): JOHN W, VAN LENTEN, D.M.D., P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

265 E MAIN ST
OCEANPORT NJ
07757-1145
US

IV. Provider business mailing address

265 E MAIN ST
OCEANPORT NJ
07757-1145
US

V. Phone/Fax

Practice location:
  • Phone: 732-542-6706
  • Fax:
Mailing address:
  • Phone: 732-542-6706
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number10399
License Number StateNJ

VIII. Authorized Official

Name: DR. JOHN W VAN LENTEN
Title or Position: PRESIDENT
Credential: D.M.D.
Phone: 732-542-6706