Provider Demographics
NPI:1558537852
Name:MAHONEY, HARRY DAVID (DDS)
Entity Type:Individual
Prefix:DR
First Name:HARRY
Middle Name:DAVID
Last Name:MAHONEY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:180 RIVER ROAD
Mailing Address - Street 2:
Mailing Address - City:RED BANK
Mailing Address - State:NJ
Mailing Address - Zip Code:07701-2330
Mailing Address - Country:US
Mailing Address - Phone:732-741-9117
Mailing Address - Fax:732-741-1326
Practice Address - Street 1:180 RIVER ROAD
Practice Address - Street 2:
Practice Address - City:RED BANK
Practice Address - State:NJ
Practice Address - Zip Code:07701-2330
Practice Address - Country:US
Practice Address - Phone:732-741-9117
Practice Address - Fax:732-741-1326
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-06
Last Update Date:2008-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI01213400122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist