Provider Demographics
NPI:1093928038
Name:WEST MONMOUTH DENTAL
Entity Type:Organization
Organization Name:WEST MONMOUTH DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SABASTIAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:D'AMICO
Authorized Official - Suffix:JR
Authorized Official - Credentials:DMD
Authorized Official - Phone:609-208-0220
Mailing Address - Street 1:PO BOX 296
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08501-0296
Mailing Address - Country:US
Mailing Address - Phone:609-208-0220
Mailing Address - Fax:609-208-0990
Practice Address - Street 1:10 SOUTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08501
Practice Address - Country:US
Practice Address - Phone:609-208-0220
Practice Address - Fax:609-208-0990
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty