Provider Demographics
NPI:1538285291
Name:BENNARDO-MEGGELIN, GEORGETTE (DDS)
Entity Type:Individual
Prefix:DR
First Name:GEORGETTE
Middle Name:
Last Name:BENNARDO-MEGGELIN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6428 84TH ST
Mailing Address - Street 2:
Mailing Address - City:MIDDLE VILLAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11379-2424
Mailing Address - Country:US
Mailing Address - Phone:718-894-7538
Mailing Address - Fax:
Practice Address - Street 1:948 TEANECK RD
Practice Address - Street 2:
Practice Address - City:TEANECK
Practice Address - State:NJ
Practice Address - Zip Code:07666-4504
Practice Address - Country:US
Practice Address - Phone:201-836-2720
Practice Address - Fax:201-568-1007
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22D1019289001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice