Provider Demographics
NPI:1285669796
Name:DEFELICE, GREGORY JOSEPH (DMD, MS)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:JOSEPH
Last Name:DEFELICE
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Gender:M
Credentials:DMD, MS
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Mailing Address - Street 1:5429 HARDING HWY
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MAYS LANDING
Mailing Address - State:NJ
Mailing Address - Zip Code:08330-2263
Mailing Address - Country:US
Mailing Address - Phone:609-625-0505
Mailing Address - Fax:609-625-8002
Practice Address - Street 1:5429 HARDING HWY
Practice Address - Street 2:SUITE 101
Practice Address - City:MAYS LANDING
Practice Address - State:NJ
Practice Address - Zip Code:08330-2263
Practice Address - Country:US
Practice Address - Phone:609-625-0505
Practice Address - Fax:609-625-8002
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PADS0354161223X0400X
NJ22DI022781031223X0400X
IL1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics