MEDICARE: DR. GARY DORNFELD D.D.S

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	22D101052201	NJ

General Provider Information

NPI Number	:	1851513675
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GARY DORNFELD D.D.S

Provider Business Mailing Address
First Line	:	131 DRUM POINT RD
Second Line	:
City	:	BRICK
State	:	NJ
Zip	:	08723-6221
Country	:	US
Telephone Number	:	732-451-0400
Fax Number	:	732-451-0500

Provider Business Practice Location Address
First Line	:	131 DRUM POINT RD
Second Line	:
City	:	BRICK
State	:	NJ
Zip	:	08723-6221
Country	:	US
Telephone Number	:	732-451-0400
Fax Number	:	732-451-0500

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

Provider Enumeration Date	:	05/02/2007
Last Update Date	:	07/08/2007

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