Provider Demographics
NPI:1659954147
Name:DENTAL HEALTH CENTER OF TOMS RIVER, LLC
Entity Type:Organization
Organization Name:DENTAL HEALTH CENTER OF TOMS RIVER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:DICARLO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:732-349-5535
Mailing Address - Street 1:1268 BOXELDER DR
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08753-3322
Mailing Address - Country:US
Mailing Address - Phone:732-349-5535
Mailing Address - Fax:
Practice Address - Street 1:1268 BOXELDER DR
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08753-3322
Practice Address - Country:US
Practice Address - Phone:732-349-5535
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-03
Last Update Date:2021-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty