Provider Demographics
NPI:1174662712
Name:CHILDREN'S DENTISTRY OF HAZLET P.A.
Entity Type:Organization
Organization Name:CHILDREN'S DENTISTRY OF HAZLET P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CRED COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:MARIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:WOLCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-914-1039
Mailing Address - Street 1:883 POOLE AVE
Mailing Address - Street 2:
Mailing Address - City:HAZLET
Mailing Address - State:NJ
Mailing Address - Zip Code:07730-2040
Mailing Address - Country:US
Mailing Address - Phone:732-739-8620
Mailing Address - Fax:732-739-8621
Practice Address - Street 1:883 POOLE AVE
Practice Address - Street 2:
Practice Address - City:HAZLET
Practice Address - State:NJ
Practice Address - Zip Code:07730-2040
Practice Address - Country:US
Practice Address - Phone:732-739-8620
Practice Address - Fax:732-739-8621
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI0174321223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty