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General NPI Number Information
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NPI Number | 1104642669
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Entity Type | Organization
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Legal Business Name | TINY TEETH OF LAKEWOOD PC
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Dates
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Enumeration Date | 12/02/2024
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Last Update Date | 12/02/2024
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Provider Practice Location Address
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Address Line | 1000 ROUTE 70 STE 8
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City | LAKEWOOD
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State | NJ
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Zip | 08701-5961
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Country | US
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Telephone | 848-245-0779
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Fax | 848-245-0780
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Provider Business Mailing Address
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Address Line | 1000 ROUTE 70 STE 8
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City | LAKEWOOD
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State | NJ
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Zip | 08701-5961
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Country | US
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Telephone | 848-245-0779
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Fax | 848-245-0780
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Authorized Official
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Title or Position | OWNER
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Name | DR. ZAKI MUSTACCHI
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Credential | DDS
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Telephone | 848-245-0779
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State |
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