Provider Demographics
NPI:1710976204
Name:WASSERLAUF, STUART A (DDS)
Entity Type:Individual
Prefix:DR
First Name:STUART
Middle Name:A
Last Name:WASSERLAUF
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:142 EMERSON ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:WOODBURY
Mailing Address - State:NJ
Mailing Address - Zip Code:08096-3235
Mailing Address - Country:US
Mailing Address - Phone:856-848-2211
Mailing Address - Fax:
Practice Address - Street 1:142 EMERSON ST
Practice Address - Street 2:SUITE B
Practice Address - City:WOODBURY
Practice Address - State:NJ
Practice Address - Zip Code:08096-3235
Practice Address - Country:US
Practice Address - Phone:856-848-2211
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ80271223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry