Provider Demographics
NPI:1467993576
Name:GSRB
Entity Type:Organization
Organization Name:GSRB
Other - Org Name:DENTALARTS GROUP PITMAN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:RAFAELA
Authorized Official - Middle Name:
Authorized Official - Last Name:AGOSTO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:267-334-0082
Mailing Address - Street 1:102 PITMAN AVE
Mailing Address - Street 2:
Mailing Address - City:PITMAN
Mailing Address - State:NJ
Mailing Address - Zip Code:08071-1572
Mailing Address - Country:US
Mailing Address - Phone:856-589-5737
Mailing Address - Fax:856-589-2670
Practice Address - Street 1:102 PITMAN AVE
Practice Address - Street 2:
Practice Address - City:PITMAN
Practice Address - State:NJ
Practice Address - Zip Code:08071-1572
Practice Address - Country:US
Practice Address - Phone:856-589-5737
Practice Address - Fax:856-589-2670
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-09
Last Update Date:2017-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty