Provider Demographics
NPI:1114264934
Name:ALLIANCE DENTAL SPECIALTIES OF EAST BRUNSWICK
Entity Type:Organization
Organization Name:ALLIANCE DENTAL SPECIALTIES OF EAST BRUNSWICK
Other - Org Name:ALLIANCE DENTAL SPECIALTIES OF PARSIPPANY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:FRATTELLONE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:732-842-5915
Mailing Address - Street 1:515 NEWMAN SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:LINCROFT
Mailing Address - State:NJ
Mailing Address - Zip Code:07738-1426
Mailing Address - Country:US
Mailing Address - Phone:732-842-5915
Mailing Address - Fax:732-842-5910
Practice Address - Street 1:1180 US HIGHWAY 46
Practice Address - Street 2:SUITE 211
Practice Address - City:PARSIPPANY
Practice Address - State:NJ
Practice Address - Zip Code:07054-2142
Practice Address - Country:US
Practice Address - Phone:973-334-2255
Practice Address - Fax:732-842-5910
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-14
Last Update Date:2013-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI009052001223P0221X, 1223X0400X
NJ22DI025127001223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
No1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty