Provider Demographics
NPI:1093735706
Name:FIORENTINI, MARIO SEVERINO (DMD)
Entity Type:Individual
Prefix:DR
First Name:MARIO
Middle Name:SEVERINO
Last Name:FIORENTINI
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 1:85 WOODBRIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:08904-3207
Mailing Address - Country:US
Mailing Address - Phone:732-545-1023
Mailing Address - Fax:732-572-5855
Practice Address - Street 1:85 WOODBRIDGE AVE
Practice Address - Street 2:
Practice Address - City:HIGHLAND PARK
Practice Address - State:NJ
Practice Address - Zip Code:08904-3207
Practice Address - Country:US
Practice Address - Phone:732-545-1023
Practice Address - Fax:732-572-5855
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist