Provider Demographics
NPI:1639195233
Name:MARIO S FIORENTINI DMD PA
Entity Type:Organization
Organization Name:MARIO S FIORENTINI DMD PA
Other - Org Name:MSF GROUP
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIO
Authorized Official - Middle Name:S
Authorized Official - Last Name:FIORENTINI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:732-545-1023
Mailing Address - Street 1:85 WOODBRIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:08904-3207
Mailing Address - Country:US
Mailing Address - Phone:732-545-1023
Mailing Address - Fax:732-572-5855
Practice Address - Street 1:85 WOODBRIDGE AVE
Practice Address - Street 2:
Practice Address - City:HIGHLAND PARK
Practice Address - State:NJ
Practice Address - Zip Code:08904-3207
Practice Address - Country:US
Practice Address - Phone:732-545-1023
Practice Address - Fax:732-572-5855
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty