Healthcare Provider Details

I. General information

NPI: 1649339060
Provider Name (Legal Business Name): FRANK BENJAMIN CANCELLIERI DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BOX 866 RANGE RD MID STATE CORRECTIONAL FACILITY CMS MEDICAL
WRIGHTSTOWN NJ
08562
US

IV. Provider business mailing address

861 COLTS NECK ROAD
FREEHOLD TWP NJ
07728-8108
US

V. Phone/Fax

Practice location:
  • Phone: 609-724-9139
  • Fax: 609-724-9124
Mailing address:
  • Phone: 732-431-5678
  • Fax: 732-431-5678

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number22D100875200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: