Provider Demographics
NPI:1679704399
Name:CRYSTAL-ORNELAS, ARI (DMD)
Entity Type:Individual
Prefix:DR
First Name:ARI
Middle Name:
Last Name:CRYSTAL-ORNELAS
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 1:111 E UNION AVE
Mailing Address - Street 2:
Mailing Address - City:BOUND BROOK
Mailing Address - State:NJ
Mailing Address - Zip Code:08805-1761
Mailing Address - Country:US
Mailing Address - Phone:732-735-2323
Mailing Address - Fax:
Practice Address - Street 1:111 E UNION AVE
Practice Address - Street 2:
Practice Address - City:BOUND BROOK
Practice Address - State:NJ
Practice Address - Zip Code:08805-1761
Practice Address - Country:US
Practice Address - Phone:732-735-2323
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-29
Last Update Date:2009-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DIO2417501122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist