MEDICARE: MARK DURANTE, D.D.S., P.A.

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	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	22DI01381600	NJ

General Provider Information

NPI Number	:	1578704508
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARK DURANTE, D.D.S., P.A.

Provider Business Mailing Address
First Line	:	261 SPRINGFIELD AVE
Second Line	:	SUITE 203
City	:	BERKELEY HEIGHTS
State	:	NJ
Zip	:	07922-1264
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	261 SPRINGFIELD AVE
Second Line	:	SUITE 203
City	:	BERKELEY HEIGHTS
State	:	NJ
Zip	:	07922-1264
Country	:	US
Telephone Number	:	908-464-4664
Fax Number	:

Authorized Official
Title or Position	:	ORAL/MAXILLOFACIAL SURG./PRES.-P.A.
Name	:	DR. MARK DURANTE
Credential	:	D.D.S.
Telephone Number	:	908-464-4664

Provider Enumeration Date	:	03/22/2009
Last Update Date	:	03/22/2009

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