Provider Demographics
NPI:1407069693
Name:FAMILY AND COSMETIC DENTISTRY,DRS. STANISLAUS AND MICHELOTTI
Entity Type:Organization
Organization Name:FAMILY AND COSMETIC DENTISTRY,DRS. STANISLAUS AND MICHELOTTI
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:RAJ
Authorized Official - Last Name:STANISLAUS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:732-409-0330
Mailing Address - Street 1:4249 US HIGHWAY 9
Mailing Address - Street 2:BUILDING 2, SUITE A
Mailing Address - City:FREEHOLD
Mailing Address - State:NJ
Mailing Address - Zip Code:07728-8308
Mailing Address - Country:US
Mailing Address - Phone:732-409-0330
Mailing Address - Fax:732-409-0353
Practice Address - Street 1:4249 US HIGHWAY 9
Practice Address - Street 2:BUILDING 2, SUITE A
Practice Address - City:FREEHOLD
Practice Address - State:NJ
Practice Address - Zip Code:07728-8308
Practice Address - Country:US
Practice Address - Phone:732-409-0330
Practice Address - Fax:732-409-0353
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI01718000122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty