MEDICARE: DR. BETH ANNE BAMBERGER DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	22DI01561200	NJ

General Provider Information

NPI Number	:	1124263124
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BETH ANNE BAMBERGER DMD

Provider Business Mailing Address
First Line	:	154 MARINA BLVD
Second Line	:
City	:	LONG BEACH TOWNSHIP
State	:	NJ
Zip	:	08008-6146
Country	:	US
Telephone Number	:	856-727-3267
Fax Number	:

Provider Business Practice Location Address
First Line	:	154 MARINA BLVD
Second Line	:
City	:	LONG BEACH TOWNSHIP
State	:	NJ
Zip	:	08008-6146
Country	:	US
Telephone Number	:	856-727-3267
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/05/2008
Last Update Date	:	02/03/2023

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