Provider Demographics
NPI:1437665973
Name:OLD BRIDGE DENTAL ARTS
Entity Type:Organization
Organization Name:OLD BRIDGE DENTAL ARTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMIN. ASST.
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:MUCCIARIELLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-750-0707
Mailing Address - Street 1:1030 SAINT GEORGES AVE
Mailing Address - Street 2:
Mailing Address - City:AVENEL
Mailing Address - State:NJ
Mailing Address - Zip Code:07001-1390
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:30 STATE HIGHWAY 18 NORTH
Practice Address - Street 2:
Practice Address - City:OLD BRIDGE
Practice Address - State:NJ
Practice Address - Zip Code:08857-3817
Practice Address - Country:US
Practice Address - Phone:732-257-5600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-20
Last Update Date:2017-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty