=====================================================
General NPI Number Information
=====================================================
NPI Number | 1558424770
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HOWARD CETEL DDS, PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/19/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 27 MAIN ST
-----------------------------------------------------
City | MANTUA
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08051-1475
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 856-464-1900
-----------------------------------------------------
Fax | 856-464-1709
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 27 MAIN ST
-----------------------------------------------------
City | MANTUA
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08051-1475
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 856-464-1900
-----------------------------------------------------
Fax | 856-464-1709
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. HOWARD CETEL
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 856-464-1900
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QD0000X
-----------------------------------------------------
Taxonomy Name | Dental Clinic/Center
-----------------------------------------------------
License Number | 14495
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------