Healthcare Provider Details

I. General information

NPI: 1609106491
Provider Name (Legal Business Name): ATLANTIC DENTAL ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/30/2009
Last Update Date: 12/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 S NEW RD
PLEASANTVILLE NJ
08232-3738
US

IV. Provider business mailing address

1400 S NEW RD
PLEASANTVILLE NJ
08232-3738
US

V. Phone/Fax

Practice location:
  • Phone: 609-641-5400
  • Fax: 609-641-4025
Mailing address:
  • Phone: 609-641-5400
  • Fax: 609-641-4025

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: LOUIS A D'ANGELO
Title or Position: MANAGING MEMBER
Credential: DMD
Phone: 609-953-7123