Provider Demographics
NPI:1205860632
Name:DEFABIO, EDWARD CHARLES (DDS)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:CHARLES
Last Name:DEFABIO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:440 NJ-34
Mailing Address - Street 2:
Mailing Address - City:COLTS NECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07722-1556
Mailing Address - Country:US
Mailing Address - Phone:732-780-7790
Mailing Address - Fax:732-780-4539
Practice Address - Street 1:440 NJ-34
Practice Address - Street 2:
Practice Address - City:COLTS NECK
Practice Address - State:NJ
Practice Address - Zip Code:07722-1556
Practice Address - Country:US
Practice Address - Phone:732-780-7790
Practice Address - Fax:732-780-4539
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2022-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI011250001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice