Healthcare Provider Details

I. General information

NPI: 1114264934
Provider Name (Legal Business Name): ALLIANCE DENTAL SPECIALTIES OF EAST BRUNSWICK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/14/2013
Last Update Date: 01/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1180 US HIGHWAY 46 SUITE 211
PARSIPPANY NJ
07054-2142
US

IV. Provider business mailing address

515 NEWMAN SPRINGS RD
LINCROFT NJ
07738-1426
US

V. Phone/Fax

Practice location:
  • Phone: 973-334-2255
  • Fax: 732-842-5910
Mailing address:
  • Phone: 732-842-5915
  • Fax: 732-842-5910

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number22DI02512700
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number22DI00905200
License Number StateNJ
# 3
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number22DI00905200
License Number StateNJ

VIII. Authorized Official

Name: DR. JOHN FRATTELLONE
Title or Position: OWNER
Credential: DMD
Phone: 732-842-5915