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General NPI Number Information
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NPI Number | 1720282502
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Entity Type | Individual
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Provider Name | LORETTA JEAN PASSAFIUME DMD
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Gender | Female
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Dates
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Enumeration Date | 06/13/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 175 WALLINGTON AVE
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City | WALLINGTON
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State | NJ
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Zip | 07057-1225
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Country | US
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Telephone | 973-473-5673
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Fax |
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Provider Business Mailing Address
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Address Line | 8 WERIMUS RD
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City | WOODCLIFF LAKE
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State | NJ
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Zip | 07677-8224
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Country | US
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Telephone | 201-320-4605
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | DIO18256
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License Number State | NJ
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