Provider Demographics
NPI:1013031871
Name:SERINI, DESIREE ANN (DMD)
Entity Type:Individual
Prefix:MRS
First Name:DESIREE
Middle Name:ANN
Last Name:SERINI
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:74 UNION AVE
Mailing Address - Street 2:
Mailing Address - City:HOLMDEL
Mailing Address - State:NJ
Mailing Address - Zip Code:07733-1117
Mailing Address - Country:US
Mailing Address - Phone:732-335-0022
Mailing Address - Fax:732-335-0021
Practice Address - Street 1:74 UNION AVE
Practice Address - Street 2:
Practice Address - City:HOLMDEL
Practice Address - State:NJ
Practice Address - Zip Code:07733-1117
Practice Address - Country:US
Practice Address - Phone:732-335-0022
Practice Address - Fax:732-335-0021
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22D1021858001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice