Healthcare Provider Details

I. General information

NPI: 1285978908
Provider Name (Legal Business Name): NORTH MONMOUTH DENTAL ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/19/2012
Last Update Date: 11/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

709 SYCAMORE AVE
TINTON FALLS NJ
07701-4946
US

IV. Provider business mailing address

709 SYCAMORE AVE
TINTON FALLS NJ
07701-4946
US

V. Phone/Fax

Practice location:
  • Phone: 732-842-6300
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number18874
License Number StateNJ

VIII. Authorized Official

Name: DR. NANCY HANNA
Title or Position: PRESIDENT
Credential: DMD
Phone: 732-842-6300