MEDICARE: ALLIANCE DENTAL SPECIALTIES OF TOMS RIVER

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	25066	NJ
2	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	25371	NJ
3	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	16514	NJ

General Provider Information

NPI Number	:	1164850327
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALLIANCE DENTAL SPECIALTIES OF TOMS RIVER

Provider Business Mailing Address
First Line	:	515 NEWMAN SPRINGS RD
Second Line	:
City	:	LINCROFT
State	:	NJ
Zip	:	07738-1426
Country	:	US
Telephone Number	:	732-842-5915
Fax Number	:	732-842-5910

Provider Business Practice Location Address
First Line	:	1510 HOOPER AVE
Second Line	:
City	:	TOMS RIVER
State	:	NJ
Zip	:	08753-2228
Country	:	US
Telephone Number	:	732-255-1516
Fax Number	:

Authorized Official
Title or Position	:	ORAL SURGEON/OWNER
Name	:	DR. JOHN FRATTELLONE
Credential	:	DMD
Telephone Number	:	732-842-5915

Provider Enumeration Date	:	10/28/2013
Last Update Date	:	10/28/2013

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