Healthcare Provider Details

I. General information

NPI: 1215913918
Provider Name (Legal Business Name): ALLIED DENTAL OF OLD BRIDGE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2005
Last Update Date: 11/19/2020
Certification Date: 11/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1070 HIGHWAY 9
PARLIN NJ
08859
US

IV. Provider business mailing address

16 WASHINGTON ST
TOMS RIVER NJ
08753-7643
US

V. Phone/Fax

Practice location:
  • Phone: 732-553-9393
  • Fax: 732-553-1910
Mailing address:
  • Phone: 732-914-1039
  • Fax: 732-914-8472

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: STEPHEN ABBATICCHIO
Title or Position: OWNER
Credential: DDS
Phone: 732-553-9393