Provider Demographics
NPI:1437264090
Name:LEON HORLICK DDS PD MARTIN NAGEL DDS
Entity Type:Organization
Organization Name:LEON HORLICK DDS PD MARTIN NAGEL DDS
Other - Org Name:DRS HORLICK & NAGEL DDS PD
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:DDS
Authorized Official - Prefix:DR
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:R
Authorized Official - Last Name:NAGEL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:732-249-4821
Mailing Address - Street 1:529 MILLTOWN RD
Mailing Address - Street 2:
Mailing Address - City:NO BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08902-3358
Mailing Address - Country:US
Mailing Address - Phone:732-249-4821
Mailing Address - Fax:732-249-3285
Practice Address - Street 1:529 MILLTOWN RD
Practice Address - Street 2:
Practice Address - City:NO BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08902-3358
Practice Address - Country:US
Practice Address - Phone:732-249-4821
Practice Address - Fax:732-249-3285
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-21
Last Update Date:2008-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22D1019021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty