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General NPI Number Information
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NPI Number | 1306162177
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Entity Type | Individual
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Provider Name | ARIEL PORT DMD
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Gender | Female
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Dates
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Enumeration Date | 04/19/2010
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Last Update Date | 04/19/2010
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Provider Practice Location Address
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Address Line | 71 DAVIS AVE
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City | NEPTUNE
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State | NJ
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Zip | 07753-4401
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Country | US
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Telephone | 732-776-4212
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Fax |
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Provider Business Mailing Address
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Address Line | 15 BRIGANTINE ST
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City | BEACHWOOD
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State | NJ
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Zip | 08722-2900
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Country | US
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Telephone |
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DI02437100
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License Number State | NJ
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