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General NPI Number Information
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NPI Number | 1891806147
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Entity Type | Organization
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Legal Business Name | MIDLAND FAMILY DENTAL CARE,PA
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 765 MIDLAND AVE
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City | GARFIELD
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State | NJ
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Zip | 07026-2100
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Country | US
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Telephone | 973-340-4484
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Fax | 973-340-2282
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Provider Business Mailing Address
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Address Line | 765 MIDLAND AVE
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City | GARFIELD
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State | NJ
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Zip | 07026-2100
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Country | US
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Telephone | 973-340-4484
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Fax | 973-340-2282
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. FRED ANTHONY PUCCIO
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Credential | DDS
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Telephone | 973-340-4484
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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 | 19162
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License Number State | NJ
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