Provider Demographics
NPI:1659560159
Name:FAND, MARVIN M (DMD)
Entity Type:Individual
Prefix:DR
First Name:MARVIN
Middle Name:M
Last Name:FAND
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:138 BEACON STR
Mailing Address - Street 2:
Mailing Address - City:HAWORTH
Mailing Address - State:NJ
Mailing Address - Zip Code:07641
Mailing Address - Country:US
Mailing Address - Phone:201-384-3515
Mailing Address - Fax:201-384-3515
Practice Address - Street 1:138 BEACON ST
Practice Address - Street 2:
Practice Address - City:HAWORTH
Practice Address - State:NJ
Practice Address - Zip Code:07641-1904
Practice Address - Country:US
Practice Address - Phone:201-384-3515
Practice Address - Fax:201-384-3515
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-19
Last Update Date:2007-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22D100677700122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist