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General NPI Number Information
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NPI Number | 1356840672
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Entity Type | Individual
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Provider Name | FERDA DEMIRTAS
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Gender | Female
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Dates
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Enumeration Date | 02/02/2018
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Last Update Date | 02/02/2018
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Provider Practice Location Address
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Address Line | 240 HALF MILE RD STE 1
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City | RED BANK
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State | NJ
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Zip | 07701-5684
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Country | US
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Telephone | 732-747-2888
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Fax |
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Provider Business Mailing Address
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Address Line | 130 LAURELWOOD RD
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City | BRICK
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State | NJ
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Zip | 08724-3648
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Country | US
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Telephone | 732-678-8952
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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 | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | 22HI01124600
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License Number State | NJ
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