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General NPI Number Information
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NPI Number | 1124076500
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Entity Type | Individual
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Provider Name | CARL ANGELO BIFANO DMD
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Gender | Male
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Dates
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Enumeration Date | 05/05/2006
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Last Update Date | 04/01/2019
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Provider Practice Location Address
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Address Line | 2 PLAZA DR STE 202
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City | SEWELL
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State | NJ
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Zip | 08080
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Country | US
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Telephone | 856-270-4100
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Fax |
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Provider Business Mailing Address
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Address Line | 1 FEDERAL ST STE SW200
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City | CAMDEN
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State | NJ
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Zip | 08103-1155
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Country | US
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Telephone | 856-356-4924
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0106X
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Taxonomy Name | Oral and Maxillofacial Pathology Dentistry
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License Number | 6833
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 1223P0106X
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Taxonomy Name | Oral and Maxillofacial Pathology Dentistry
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License Number | DI02457900
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License Number State | NJ
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Taxonomy #3
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | DS019214L
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License Number State | PA
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Taxonomy #4
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Taxonomy Code | 204E00000X
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Taxonomy Name | Oral & Maxillofacial Surgery (D.M.D.)
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License Number | 22D102457901
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License Number State | NJ
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