Provider Demographics
NPI:1770649055
Name:CHILDREN'S DENTAL SPECIALISTS
Entity Type:Organization
Organization Name:CHILDREN'S DENTAL SPECIALISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:MAZZONE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:908-879-9980
Mailing Address - Street 1:407 BOULDER RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:RANDOLPH
Mailing Address - State:NJ
Mailing Address - Zip Code:07869-1637
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:245 MAIN ST
Practice Address - Street 2:SUITE 103
Practice Address - City:CHESTER
Practice Address - State:NJ
Practice Address - Zip Code:07930-2569
Practice Address - Country:US
Practice Address - Phone:908-879-9980
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty