Healthcare Provider Details

I. General information

NPI: 1760595375
Provider Name (Legal Business Name): ANTHONY MARTIN KESTLER DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

308 EAST FRONT ST
PLAINFIELD NJ
07060
US

IV. Provider business mailing address

308 EAST FRONT ST
PLAINFIELD NJ
07060
US

V. Phone/Fax

Practice location:
  • Phone: 908-756-3643
  • Fax: 908-756-7557
Mailing address:
  • Phone: 908-756-3643
  • Fax: 908-756-7557

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number9937
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier2813408
Identifier TypeMEDICAID
Identifier StateNJ
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: