Provider Demographics
NPI:1639355399
Name:POMPTON FAMILY DENTAL SERVICES, PA
Entity Type:Organization
Organization Name:POMPTON FAMILY DENTAL SERVICES, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:K
Authorized Official - Last Name:FITZSIMMONS
Authorized Official - Suffix:
Authorized Official - Credentials:D M D
Authorized Official - Phone:973-831-9100
Mailing Address - Street 1:500 ROUTE 23
Mailing Address - Street 2:STE. 15
Mailing Address - City:POMPTON PLAINS
Mailing Address - State:NJ
Mailing Address - Zip Code:07444-1853
Mailing Address - Country:US
Mailing Address - Phone:973-831-9100
Mailing Address - Fax:973-831-6047
Practice Address - Street 1:500 ROUTE 23
Practice Address - Street 2:STE. 15
Practice Address - City:POMPTON PLAINS
Practice Address - State:NJ
Practice Address - Zip Code:07444-1853
Practice Address - Country:US
Practice Address - Phone:973-831-9100
Practice Address - Fax:973-831-6047
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-12
Last Update Date:2008-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI009848001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty