MEDICARE: DENA CONSTANDELIS

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	22DI02448000	NJ

General Provider Information

NPI Number	:	1265743439
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DENA CONSTANDELIS

Provider Business Mailing Address
First Line	:	48 ABBOTT RD
Second Line	:
City	:	TOWACO
State	:	NJ
Zip	:	07082-1252
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	465 VALLEY RD
Second Line	:
City	:	CLIFTON
State	:	NJ
Zip	:	07013-2234
Country	:	US
Telephone Number	:	973-684-1078
Fax Number	:

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

Provider Enumeration Date	:	06/23/2010
Last Update Date	:	09/06/2011

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Directions to “ DENA CONSTANDELIS ” Practice Location

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