Provider Demographics
NPI:1104860196
Name:FIEDLER, ROBERT S (DMD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:S
Last Name:FIEDLER
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 1:199 NEW RD
Mailing Address - Street 2:CENTRAL SQUARE SUITE 32
Mailing Address - City:LINWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08221-2025
Mailing Address - Country:US
Mailing Address - Phone:609-927-9090
Mailing Address - Fax:609-927-9091
Practice Address - Street 1:199 NEW RD
Practice Address - Street 2:CENTRAL SQUARE SUITE 32
Practice Address - City:LINWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08221-2025
Practice Address - Country:US
Practice Address - Phone:609-927-9090
Practice Address - Fax:609-927-9091
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-16
Last Update Date:2010-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ17511204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJT77590Medicare UPIN
FI093498Medicare ID - Type Unspecified