Provider Demographics
NPI:1346393717
Name:ATANASE, CORINA (DMD)
Entity Type:Individual
Prefix:
First Name:CORINA
Middle Name:
Last Name:ATANASE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 MAIN STREET
Mailing Address - Street 2:STE. 101
Mailing Address - City:CHATHAM
Mailing Address - State:NJ
Mailing Address - Zip Code:07928-2314
Mailing Address - Country:US
Mailing Address - Phone:973-635-0626
Mailing Address - Fax:973-507-9395
Practice Address - Street 1:33 MAIN STREET
Practice Address - Street 2:STE. 101
Practice Address - City:CHATHAM
Practice Address - State:NJ
Practice Address - Zip Code:07928-2314
Practice Address - Country:US
Practice Address - Phone:973-635-0626
Practice Address - Fax:973-507-9395
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-19
Last Update Date:2011-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI02372900122300000X
CT86691223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ22DI02372900OtherSTATE LICENSE #
NJ6485920001Medicare NSC