Provider Demographics
NPI:1851423461
Name:MARC MEHLMAN
Entity Type:Organization
Organization Name:MARC MEHLMAN
Other - Org Name:TINTON FALLS DENTAL ASSOCIATES PA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARC
Authorized Official - Middle Name:
Authorized Official - Last Name:MEHLMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:732-542-4433
Mailing Address - Street 1:613 HOPE RD
Mailing Address - Street 2:BLDG 5
Mailing Address - City:EATONTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07724-1278
Mailing Address - Country:US
Mailing Address - Phone:732-542-4433
Mailing Address - Fax:732-389-0304
Practice Address - Street 1:1029 SYCAMORE AVE
Practice Address - Street 2:
Practice Address - City:TINTON FALLS
Practice Address - State:NJ
Practice Address - Zip Code:07724-3181
Practice Address - Country:US
Practice Address - Phone:732-542-4433
Practice Address - Fax:732-389-0304
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-09
Last Update Date:2012-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ152361223G0001X
NJ141421223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty