Provider Demographics
NPI:1083706527
Name:ERNST, FREDERICK HARRISON (DMD)
Entity Type:Individual
Prefix:DR
First Name:FREDERICK
Middle Name:HARRISON
Last Name:ERNST
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 KINGSLAND ROAD
Mailing Address - Street 2:
Mailing Address - City:BOONTON TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:07005
Mailing Address - Country:US
Mailing Address - Phone:973-263-4097
Mailing Address - Fax:
Practice Address - Street 1:150 RIVER RD STE H2
Practice Address - Street 2:
Practice Address - City:MONTVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07045-8922
Practice Address - Country:US
Practice Address - Phone:973-316-5757
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2012-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI013039001223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ585223AUQMedicare PIN
NJ585223Medicare PIN