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General NPI Number Information
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NPI Number | 1790811156
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Entity Type | Individual
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Provider Name | JOSEPH A DEANTONIO SR. DMD
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Gender | Male
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Dates
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Enumeration Date | 02/27/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 130 MAPLE AVE STE 2AS
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City | RED BANK
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State | NJ
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Zip | 07701
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Country | US
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Telephone | 732-741-1888
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Fax | 732-741-7710
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Provider Business Mailing Address
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Address Line | 12 ADAMS PLACE
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City | FREEHOLD
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State | NJ
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Zip | 07728
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Country | US
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Telephone | 732-780-1163
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Fax | 732-741-7710
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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 | 22D100897300
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License Number State | NJ
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