Provider Demographics
NPI:1528020245
Name:DICESARE, DANIEL (DMD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:DICESARE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1144 HOOPER AVE
Mailing Address - Street 2:SUITE 201 B
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08753-8361
Mailing Address - Country:US
Mailing Address - Phone:732-914-1039
Mailing Address - Fax:
Practice Address - Street 1:1144 HOOPER AVE
Practice Address - Street 2:SUITE 201 B
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08753-8361
Practice Address - Country:US
Practice Address - Phone:732-914-1039
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-06
Last Update Date:2010-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ211281223G0001X
PADS0382041223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice