Provider Demographics
NPI:1598364226
Name:DENVILLE DENTAL GROUP
Entity Type:Organization
Organization Name:DENVILLE DENTAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:MATARAZZO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:973-627-6053
Mailing Address - Street 1:111 BLOOMFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:DENVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07834-2701
Mailing Address - Country:US
Mailing Address - Phone:973-627-6053
Mailing Address - Fax:
Practice Address - Street 1:111 BLOOMFIELD AVE
Practice Address - Street 2:
Practice Address - City:DENVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07834-2701
Practice Address - Country:US
Practice Address - Phone:973-627-6053
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-23
Last Update Date:2020-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental