Provider Demographics
NPI:1821118217
Name:DENNIS, ALFRED D (DMD)
Entity Type:Individual
Prefix:DR
First Name:ALFRED
Middle Name:D
Last Name:DENNIS
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 1:63 GARRETT LN
Mailing Address - Street 2:
Mailing Address - City:WILLINGBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:08046-3056
Mailing Address - Country:US
Mailing Address - Phone:609-871-0900
Mailing Address - Fax:609-835-4065
Practice Address - Street 1:63 GARRETT LN
Practice Address - Street 2:
Practice Address - City:WILLINGBORO
Practice Address - State:NJ
Practice Address - Zip Code:08046-3056
Practice Address - Country:US
Practice Address - Phone:609-871-0900
Practice Address - Fax:609-835-4065
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI16782122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist