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General NPI Number Information
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NPI Number | 1407859069
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Entity Type | Individual
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Provider Name | ANTONELLA GIOVANNA RITA MAIETTA DMD
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Gender | Female
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Dates
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Enumeration Date | 05/27/2005
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Last Update Date | 01/08/2013
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Provider Practice Location Address
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Address Line | 17 S WARREN ST
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City | DOVER
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State | NJ
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Zip | 07801-4506
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Country | US
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Telephone | 973-328-3344
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Fax |
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Provider Business Mailing Address
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Address Line | 105 HOBART PL
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City | TOTOWA
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State | NJ
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Zip | 07512-2110
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Country | US
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Telephone | 973-943-9161
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Fax | 973-471-3740
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | DI21305
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License Number State | NJ
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