Provider Demographics
NPI:1578704508
Name:MARK DURANTE, D.D.S., P.A.
Entity Type:Organization
Organization Name:MARK DURANTE, D.D.S., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORAL/MAXILLOFACIAL SURG./PRES.-P.A.
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:DURANTE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:908-464-4664
Mailing Address - Street 1:261 SPRINGFIELD AVE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:BERKELEY HEIGHTS
Mailing Address - State:NJ
Mailing Address - Zip Code:07922-1264
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:261 SPRINGFIELD AVE
Practice Address - Street 2:SUITE 203
Practice Address - City:BERKELEY HEIGHTS
Practice Address - State:NJ
Practice Address - Zip Code:07922-1264
Practice Address - Country:US
Practice Address - Phone:908-464-4664
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-22
Last Update Date:2009-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI013816001223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ503397Medicare PIN