Provider Demographics
NPI:1083938484
Name:EASTON DENTAL PC
Entity Type:Organization
Organization Name:EASTON DENTAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:ABBATICCHIO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:609-484-5996
Mailing Address - Street 1:2441 NAZARETH RD
Mailing Address - Street 2:STORE 8
Mailing Address - City:EASTON
Mailing Address - State:PA
Mailing Address - Zip Code:18045-2743
Mailing Address - Country:US
Mailing Address - Phone:610-250-7177
Mailing Address - Fax:610-250-7118
Practice Address - Street 1:1144 HOOPER AVE
Practice Address - Street 2:SUITE 201B
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08753-8361
Practice Address - Country:US
Practice Address - Phone:732-914-1039
Practice Address - Fax:732-914-8472
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-15
Last Update Date:2019-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS038181122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty