MEDICARE: POMPTON FAMILY DENTAL SERVICES, PA

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	22DI00984800	NJ

General Provider Information

NPI Number	:	1639355399
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	POMPTON FAMILY DENTAL SERVICES, PA

Provider Business Mailing Address
First Line	:	500 ROUTE 23
Second Line	:	STE. 15
City	:	POMPTON PLAINS
State	:	NJ
Zip	:	07444-1853
Country	:	US
Telephone Number	:	973-831-9100
Fax Number	:	973-831-6047

Provider Business Practice Location Address
First Line	:	500 ROUTE 23
Second Line	:	STE. 15
City	:	POMPTON PLAINS
State	:	NJ
Zip	:	07444-1853
Country	:	US
Telephone Number	:	973-831-9100
Fax Number	:	973-831-6047

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. STEPHEN K FITZSIMMONS
Credential	:	D. M. D.
Telephone Number	:	973-831-9100

Provider Enumeration Date	:	01/12/2008
Last Update Date	:	01/12/2008

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