Provider Demographics
NPI:1396860581
Name:CANGIALOSI, THOMAS JEROME (DDS)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:JEROME
Last Name:CANGIALOSI
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 1:20 WHITE RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:SHREWSBURY
Mailing Address - State:NJ
Mailing Address - Zip Code:07702-4039
Mailing Address - Country:US
Mailing Address - Phone:732-842-5141
Mailing Address - Fax:
Practice Address - Street 1:20 WHITE RD
Practice Address - Street 2:SUITE C
Practice Address - City:SHREWSBURY
Practice Address - State:NJ
Practice Address - Zip Code:07702-4039
Practice Address - Country:US
Practice Address - Phone:732-842-5141
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ0070031223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics