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General NPI Number Information
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NPI Number | 1801912647
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Entity Type | Organization
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Legal Business Name | HOLLY BEACH DENTAL ASSOCIATES
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Dates
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Enumeration Date | 03/22/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 4301 NEW JERSEY AVE
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City | WILDWOOD
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State | NJ
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Zip | 08260-1824
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Country | US
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Telephone | 609-522-1471
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Fax | 609-522-5473
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Provider Business Mailing Address
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Address Line | 4301 NEW JERSEY AVE PO BOX 1326
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City | WILDWOOD
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State | NJ
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Zip | 08260-1824
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Country | US
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Telephone | 609-522-1471
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Fax | 609-522-5473
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Authorized Official
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Title or Position | SECRETARY
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Name | DR. FRANK FUSCALDO
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Credential | DDS
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Telephone | 609-522-1471
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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 |
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License Number State | NJ
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